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Performance Measurement Codes

March 28, 2014

Effective July 1, 2014, Blue Cross and Blue Shield of Texas (BCBSTX) will begin reimbursing additional Category II CPT codes. The complete list is outlined below.

Category II Code

Description

0500F

Initial prenatal care visit (report as first prenatal encounter with health care professional providing obstetrical care)

0501F

Prenatal flow sheet documented in medical record by first prenatal visit

0503F

Postpartum care visit

0518F

Falls plan of care documented

1003F

Level of activity assessed

1022F

Pneumococcus immunization status assessed

1030F

Influenza immunization status assessed

1034F

Current tobacco smoker

1035F

Current smokeless tobacco user

1100F

Patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year

1111F

Discharge medications reconciled with the current medication list in outpatient medical record

1123F

Advance Care Planning discussed & documented; advance care plan or surrogate decision maker documented in the medical record

1124F

Advance Care Planning discussed and documented in the medical record; patient did not wish or was not able to name a surrogate decision maker or provide and advance care plan

1157F

Advance care plan or similar legal document present in the medical record

1158F

Advance care planning discussion documented in the medical record

3011F

Lipid panel results documented and reviewed (must include total cholesterol, HDL-C, triglycerides and calculated LDL-C)

3014F

Screening mammography results documented
and reviewed

3015F

Cervical Cancer screening results documented and reviewed

3017F

Colorectal cancer screening results documented and reviewed

3023F

Spirometry results documented and reviewed

3025F

Spirometry test results demonstrate FEV1/FVC less than 70% with COPD symptoms

3027F

Spirometry test results demonstrate FEV1/FVC greater than or equal to 70% or patient does not have COPD symptoms

3044F

Most recent hemoglobin A1C level < 7.0%

3045F

Most recent hemoglobin A1C level 7.0% to 9.0%

3046F

Most recent hemoglobin A1C level > 9.0%

3048F

Most recent LDL-C < 100mg/dL

3049F

Most recent LDL-C 100-129mg/dL

3050F

Most recent LDL-C ≥130mg/dL

3060F

Positive microalbuminuria test result documented and reviewed

3061F

Negative microalbuminuria test result documented and reviewed

3062F

Positive macroalbuminuria test result documented and reviewed

3210F

Group A Strep Test Performed

3288F

Falls risk assessment documented

3330F

Imaging study ordered

3331F

Imaging study not ordered

4000F

Tobacco use cessation intervention, counseling

4001F

Tobacco use cessation intervention, pharmacologic therapy

4004F

Patient screened for tobacco use AND received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user

4008F

Beta-blocker prescribed or currently being taken

4025F

Inhaled bronchodilator prescribed

4035F

Influenza immunization recommended

4037F

Influenza immunization ordered or administered

4040F

Pneumococcal vaccine administered or previously received

4050F

Hypertension plan of care documented as appropriate

4124F

Antibiotic neither prescribed nor dispensed

4140F

Inhaled corticosteroids prescribed

4144F

Alternative long-term control medication prescribed

These codes facilitate data collection about quality of care. They allow physicians to report services based on nationally established, evidence based performance guidelines for improving quality of patient care. The codes will provide us with information unavailable from claims data. We encourage physicians to report these codes. Reimbursing these codes supports the BCBSTX goal of improving the health of the population and our focus on wellness. 

Note: When billing Category II Codes, submit your usual charge. Please do not submit the codes with a $0 charge.