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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.

The Federal Employee Program® and FEP® are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey.

Published on: September 30, 2022, 05:39 a.m. ET
Last updated on: October 20, 2022, 21:38 p.m. ET