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Jan 1, 2020

Hints for HEDIS

The following CPT Category II Codes have been updated by the American Medical Association (AMA). Please reference these revised, expired, and new codes when addressing care opportunities for quality care services. If you have any questions, please contact your quality concierge representative by phone at (401) 459-1005 or by email at QualityHEDIS@bcbsri.org.

Diabetes – Eye Exam
2022F
Revised
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy.
2023F
New
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy.
2024F
Revised
Seven standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy.
2025F
New
Seven standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy.
2026F
Revised
Eye imaging validated to match diagnosis from seven standard field stereoscopic retinal photos; results documented and reviewed; with evidence of retinopathy.
2033F
New
Eye imaging validated to match diagnosis from seven standard field stereoscopic retinal photos; results documented and reviewed; without evidence of retinopathy.
Diabetes – Hemoglobin A1c Control
3045F
Deleted
Has expired. See 3051F, 3052F.
3051F
New
Hb A1c level greater than or equal to 7.0 and less than 8.0.
3052F
New
Hb A1c level greater than or equal to 8.0 and less than or equal to 9.0.
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