CPT Modifier 1P

Medical reasons.

In general, Physician Quality Reporting System (PQRS) quality measures consist of a numerator and a denominator that permit the calculation of the percentage of a defined patient population that receive a particular process of care or achieve a particular outcome.

  • Where a patient falls in the denominator population, but specifications define circumstances in which a patient may be excluded from the measure’s denominator population, CPT Category II code modifiers 1P, 2P, and 3P are available to describe medical, patient, or system reasons, respectively, for such exclusion
  • CPT modifier 1P: the quality measure was not applied due to medical reasons
  • This modifier is only valid with some measures
  • This modifier may only be reported with the CPT Category II codes for quality measures. It does not apply to HCPCS codes for quality measures.
  • Refer to each individual quality measure for specific indications for this modifier
Reference: The AMA website contains an alphabetical index of performance measures by clinical condition or topic.

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