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