Medicare Electronic Prescribing Bonus Codes for 4.X

On April 1, 2009, the electronic precribing in SOAPware v4.x will not meet all the requirements for participation in the Medicare electronic prescribing bonus. You must also have access to sources providing patient eligibility/formulary information and fill history for prescriptions.

For additional information regarding this initiative, see The 2009 Physician Quality Reporting Initiative (PQRI) & E-Prescribing Incentive Program.

Practices that meet the e-prescribing criteria will be eligible for a 2 percent bonus in 2009 and 2010, a 1 percent bonus in 2011 and 2012 and a 0.5 percent bonus in 2013. Practices not e-prescribing will face a 1 percent cut in 2012 and 2013. That cut will grow to 2 percent in 2014 and beyond. 

In order to participate, physicians simply add one of three G codes to their Medicare claims for patient encounters:

Shortcut  G-code             Description                                                     Explanation

Do NOT submit these G-codes after April 1, 2009 if only using SOAPware v4.

In the Plan field, the shortcuts can be used.

The applicable G-code must be listed as an additional procedure code on the standard claim form. However, it appears the electronic prescribing G-code has to be listed with one of the below codes in order for the G-code to be valid.

• (New Patient) 99201, 99202, 99203, 99204, 99205
• (Established Patient) 99211, 99212, 99213, 99214, 99215
• (Consultations) 99241, 99242, 99243, 99244, 99245
• (Psych Services) 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809
• (Behavioral Assessment) 96150, 96151, 96152
• (Screening & Diabetic Training) G0101, G0108, G0109.
• (Eye Codes) 92002, 92004, 92012, 92014

To load the Medicare Codes use the following instructions...

1. DOWNLOAD the Shortcut Codes, below in the "Files" section. 
2. You now need to import the codes to SOAPware 4.X, Start > All Programs > SOAPware > Customization Editor or C:\SOAPware\Utilities\fscommand\CustomizationEditor.exe
3. In the Customization Editor, click File > Import > browse to the location where you downloaded the "MedicareCode.xml" & select it > click Open > the Import Codes window will appear, click OK to finalize the Import.
4. The codes will now be useable from within SOAPware 4.X.  

 12/15/2008 AMA News - Medicare e-prescribing: How to receive your 2% bonus. A new CMS guide gives doctors information on the bonus initiative.

Also see:

Pay for Performance (P4P) Initiatives

PQRI - Physicians Quality Reporting Initiative