February 20, 2020
In October, the National Committee for Quality Assurance (NCQA) released value set changes. These are changes to the codes and values needed to calculate and report HEDIS® Quality measures. Changes have been made to the following measures:
CDC: HbA1c: Two new procedure codes (3051F and 3052F) were added to better capture HbA1c levels. Code 3045F (HbA1c level 7.0–9.0%) should no longer be used. When conducting an HbA1c in your office, submit the distinct numeric results on the HbA1c claim with the appropriate CPT® II code:
CDC: Retinal eye exam: One new procedure code (2023F) was added to capture negative eye exam results, which result in 2 years of compliance for HEDIS®. The code descriptor for 2022F was also revised to indicate its use for a positive eye exam. When results are received from an eye care professional, submit the results on a $0.01 claim with the appropriate CPT II code:
CBP: The measure has been revised to allow for administrative closure through claims. Submit blood pressure CPT II codes for each office visit:
Learn more about the CDC and CBP measures, including who’s included in the measure, exclusions, tips, and more.
For more information and/or questions regarding the article above, email ProviderClinicalConsulting@premera.com.
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