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:
- Comprehensive Diabetes Care (CDC): HbA1c control
- Comprehensive Diabetes Care (CDC): Retinal eye exam
- Controlling High Blood Pressure (CBP)
Important Changes
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:
| CPT II code |
Most recent HbA1c level |
| 3044F |
<7% |
| 3046F |
>9% |
| 3051F |
>7% and <8% |
| 3052F |
>8% and <9% |
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:
| CPT II code |
Retinal eye exam findings |
| 2022F |
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy |
| 32023F |
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy |
| 3072F |
Low risk for retinopathy (no evidence of retinopathy in the prior year) |
CBP: The measure has been revised to allow for administrative closure through claims. Submit blood pressure CPT II codes for each office visit:
| CPT II code |
Most recent systolic blood pressure |
| 3074F |
<130 mm Hg |
| 3075F |
130–139 mm Hg |
| 3077F |
≥140 mm Hg |
| CPT II code |
Most recent diastolic blood pressure |
| 3078F |
<80 mm Hg |
| 3079F |
80–89 mm Hg |
| 3080F |
≥90 mm Hg |
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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