Performance Measurement Codes
Effective July 1, 2014, Blue Cross and Blue Shield of Texas (BCBSTX) is 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 |
|
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 |
|
4013F |
Statin therapy 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.
Notes:
- When billing Category II Codes, submit your usual charge. Please do not submit the codes with a $0 charge.
- Reimbursement of Category II codes is not applicable for Federal employees, Blue Card members, Medicare Primary members or providers not contracted with BCBSTX.
