May 2, 2019
What are CPT® Category II and Z codes?
CPT Category II codes are performance measurement tracking codes. Z codes are health status diagnosis codes. Certain CPT II codes and Z codes facilitate data collection for the Healthcare Effectiveness Data and Information Set (HEDIS®) measures. Used together when submitting claims, they can give you credit for quality of care without the need for medical record review or the submission of supplemental data and can help close gaps for HEDIS measures.
CPT Category II codes describe clinical performance measures that are usually included in the evaluation and management process such as HbA1c or blood pressure values. They’re entered in the procedure code field similar to CPT Category I codes.
Z codes are ICD-10 diagnosis codes that describe a patient’s health status. For example, by submitting a claim with the appropriate Z code to indicate a patient’s body mass index, the need to submit the member’s medical record to validate BMI documentation may be eliminated.
View a claims coding tip sheet with frequently used CPT II and ICD-10 codes for HEDIS measures.