Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet

CPT category II codes are used to measure performance on quality metrics in the Healthcare Effectiveness Data and Information Set (HEDIS) and the Care-Based Incentive (CBI) program The Alliance uses them to track and fulfill your CBIs.

CPT II Category Codes always consists of…

CPT current procedural terminology II codes were developed by the American Medical Association (AMA) as a supplemental performance tracking set of procedural codes in addition to the Category I and III coding sets.

Category II codes are optional, and cannot be used to replace Category I codes for billing purposes.

The Alliance highly encourages clinical office and billing staff to use CPT Category II codes for performance measurement in order to decrease the need for provider data submission, record abstraction and chart review - your payments, faster!

CPT Code Functions

Category I Codes	E&M, ANES, SURG, RAD, LAB
Category II Codes	TRACKING
Category III Codes	EMERGING TECH

CPT Codes

Chronic Diabetes Care
Diabetic Retinal Screening with Eye Care Professional
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy (DM)	2022F
7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy (DM)	2024F
Eye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed; with evidence of retinopathy (DM)	2026F
Diabetic Retinal Screening Negative
Low risk for retinopathy (no evidence of retinopathy in the prior year) (DM)	3072F
HbA1c Test Result
HbA1c Level <7.0%	3044F
HbA1c Level 7.0-7.9%	3051F
HbA1c Level 8.0-9.0%	3052F
HbA1c Level >9.0%	3046F

Controlling Blood Pressure (CBP)
Systolic <130 mm Hg	3074F
Systolic 130-139 mm Hg	3075F
Systolic ≥140 mm Hg	3077F
Diastolic <80 mm Hg	3078F
Diastolic 80-89 mm Hg	3079F
Diastolic ≥90 mm Hg	3080F

Prenatal Care (PNC)
Initial Prenatal Care Visit	0500F
Stand Alone Prenatal	0501F
Subsequent Prenatal Care Visit	0502F

Postpartum Care (PPC)
Postpartum Care Visit	0503F

Tobacco Screening
Patient screened for tobacco use AND received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user	1036F
Patient Screened for Tobacco Use and Identified as a Non-User of Tobacco	4004F

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Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet

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