Hardship codes

Under 2011 Electronic Prescribing Incentive Program if an Eligible Professional is not a successful electronic prescriber then the payment will be reduced by 1 percent during the 2012 payment adjustment reporting period. To avoid such adjustment CMS introduced new codes, especially for the professional who is unable to submit prescriptions electronically due to a system hardship (e.g., rural without internet, limited available pharmacies for electronic prescribing, or does not have prescribing privileges) referred to as hardship codes.

These G-codes are to be used only when an eligible professional wishes to request a significant hardship exemption from the application of the 2012 payment adjustment reporting period (January 1 through June 30, 2011). The codes are:

G8642: The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.

G8643: The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.

Another reporting option: When the eligible professional does not have prescribing privileges, report G8644 via claims. If this code is utilized, the eligible professional may not be considered for a payment adjustment.