CPT® Category II Incentive Program - FEP Plan Members
You can earn incentives when you submit CPT® Category II Codes that close care gaps for Federal Employee Plan (FEP) members. This is for claims submitted with dates of service on and after November 1, 2022 and includes the following HEDIS® measures:
- Controlling Blood Pressure (CBP)
- Hemoglobin A1c Control for Patients with Diabetes (HBD)
- Timeliness of Prenatal Care (PPC)
The table below includes the specific measures and codes that are eligible.
| HEDIS® Code | Measure | CPT® Category II Code for Incentive | Incentive Amount |
|---|---|---|---|
| CBP (Systolic Value) | Controlling High Blood Pressure (Value) Systolic >/= to 140 mmHg | 3077F Filed with ICD-10 DIAG CODE: I10 |
$5 |
| Controlling High Blood Pressure (Value) Systolic 130-139 mmHg | 3075F Filed with ICD-10 DIAG CODE: I10 |
$5 | |
| Controlling High Blood Pressure (Value) Systolic < 130 mmHg | 3074F Filed with ICD-10 DIAG CODE: I10 |
$5 | |
| CBP (Diastolic Value) | Controlling High Blood Pressure (Value) Diastolic >/= 90 mmHg | 3080F Filed with ICD-10 DIAG CODE: I10 |
$5 |
| Controlling High Blood Pressure (Value) Diastolic 80-89 mmHg | 3079F Filed with ICD-10 DIAG CODE: I10 |
$5 | |
| CBP | Controlling High Blood Pressure (Value) Diastolic < 80 mmHg | 3078F Filed with ICD-10 DIAG CODE: I10 |
$5 |
| HBD | Hemoglobin A1c Control for Patients with Diabetes - HbA1c level greater than 9.0 (Diabetic members only) | 3046F Filed with ICD-10 DIAG CODES: E10.9, E10.10-E13.9, O24.011-O24.33, O24.811-O24.83 |
$10 |
| Hemoglobin A1c Control for Patients with Diabetes - HbA1c level greater than or equal to 8.0 and less than 9.0 (Diabetic members only) | 3052F File with ICD-10 DIAG CODES: E10.9, E10.10-E13.9, O24.011-O24.33, O24.811-O24.83 |
$10 | |
| Hemoglobin A1c Control for Patients with Diabetes - HbA1c level greater than or equal to 7.0 and less than 8.0 (Diabetic members only) | 3051F Filed with ICD-10 DIAG CODES: E10.9, E10.10-E13.9, O24.011-O24.33, O24.811-O24.83 |
$10 | |
| Hemoglobin A1c Control for Patients with Diabetes - HbA1c level less than 7.0 (Diabetic members only) | 3044F File with ICD-10 DIAG CODES: ICD-10-E10.9, E10.10-E13.9, O24.011-O24.33, O24.811-O24.83 |
$10 | |
| PPC | Prenatal Care | 0500F, 0501F, 0502F File with ICD-10 DIAG CODES: Use appropriate code from “O” family; Z03.71-Z03.75, Z03.79, Z34.00-Z34.03, Z34.80-Z34.83, Z34.90-Z34.93, Z36 |
$10 |
If you have questions, please email Tia_Leary@HorizonBlue.com and Nellie_Torres@HorizonBlue.com.
Published on: September 30, 2022, 05:39 a.m. ET
Last updated on: October 20, 2022, 21:38 p.m. ET