In order to promote the adoption and use of e-prescribing systems, the “Medicare Improvements for Patients and Providers Act of 2008”  authorized an e-prescribing incentive program beginning January 1, 2009.

This program will provide eligible professionals who successfully e-prescribe an incentive of two percent of the total estimated allowed charges for professional services covered by Medicare Part B and furnished by an eligible professional during the reporting period of one calendar year. 

This program removes the e-prescribing quality measure from the Physician Quality Reporting Initiative, and creates a separate incentive program based solely on electronic prescribing. As these are two independent programs, you will not be penalized for participating in one program, but not the other. This also means that an eligible professional can potentially get two incentive payments: one for being a “successful e-prescriber” and one for satisfactorily submitting data on other quality measures under the PQRI.

Who is eligible?

An eligible professional is one who currently uses, or has used, a qualified e-prescribing system, and whose estimated Part B charges for the e-prescribing measure codes are at least 10 percent of their total Part B allowed charges.

Who is a “successful” e-prescriber?

A successful e-prescriber must report the e-prescribing quality measure at least 50 percent of applicable cases during the reporting year.

How do I know if an e-prescribing system is qualified?

Qualified systems are capable of all of the following:

• Generating a complete active medication list that incorporates electronic data received from applicable pharmacies and benefit managers (PBMs), if available.

• Selecting medications, print prescriptions, electronically transmit prescriptions, and conduct all alerts.

• Providing information related to lower cost, therapeutically appropriate alternatives (if any).

  Note: The availability of an e prescribing system to receive tiered formulary information, if available, would meet this requirement.

• Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan.

For more information on securing an electronic prescribing system or verifying that your current system is in compliance, click here.

How do I report the e-prescribing measure?

The measure includes both a denominator HCPCS code and a numerator G-code that is to be reported, on the claim for each patient visit during the reporting period that meets the denominator coding criteria.

The incentive will be paid to those professionals whose e-prescribing measure codes are at least 10 percent of their total Part B allowed charges. Even if you are not sure if the Medicare service you bill for with these denominator codes will exceed 10 percent of your Medicare revenues, you should report the e prescribing codes.

To report, simply:

• Bill on one of the following denominator codes:

  90801 90802 90804 90805 90806 90807

  90808 90809 92002 92004 92012 92014

  96150 96151 96152 99201 99202 99203

  99204 99205 99211 99212 99213 99214

  99215 99241 99242 99243 99244 99245

  G0101 G0108 G0109

• If you employ a qualified e prescribing system, report one of the following numerator G-codes if it applies to the patient visit:

  Code	Description
  G8443	All prescriptions created during the encounter were generated using a qualified e-prescribing system.
  G8445	No prescriptions were generated during the encounter, but the provider does have access to a qualified e-prescribing system.
  G8446	The provider does have access to a qualified e-prescribing system, but: Some or all prescriptions generated during the encounter were printed or phoned in as required by state or federal law or regulations, patient request, or pharmacy system being unable to receive electronic transmission - or - The prescription was not e-prescribed because it was for narcotics or other controlled substances.

For more information on the e-prescribing quality measure, the associated codes, and the procedures for reporting data on the quality measure, visit www.cms.hhs.gov/PQRI. Select “E-prescribing Incentive Program,” or contact Itara Barnes in the ACR’s Practice Advocacy department at .

Ask a Coding Question through ACR Discussion Forums