Performance Measurement Codes

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March 28, 2014

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 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
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.