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 |
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