CPT Codes
What are CPT® II codes?
Category II CPT® Codes are supplemental tracking codes used to measure performance. It is anticipated that
the use of these codes will decrease the need for record abstraction and chart review and assist the provider
in minimizing the administrative burden in measuring the quality of patient care. They are intended to
facilitate data collection about the quality of care rendered by coding certain services and test results that
support nationally established performance measures (HEDIS) and that have an evidence base as
contributing to quality patient care.
How are CPT® II codes developed?
Category II codes are reviewed by the Performance Measures Advisory Group (PMAG), an advisory body to
the CPT® Editorial Panel and the CPT®/HCPAC Advisory Committee. The PMAG is comprised of performance
measurement experts representing the Agency for Healthcare Research and Quality (AHRQ), the American
Medical Association (AMA), the Centers for Medicare and Medicaid Services (CMS), the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA),
and the Physician Consortium for Performance Improvement. The PMAG may seek additional expertise
and/or input from other national health care organizations, as necessary, for the development of tracking
codes. These may include national medical specialty societies, other national health care professional
associations, accrediting bodies, and federal regulatory agencies.
Why should I use CPT® II codes?
These codes describe clinical components that may be typically included in evaluation and management
services or clinical services and, therefore, do not have a relative value associated with them. Category II
codes may also describe results from clinical laboratory or radiology tests and other procedures, identified
processes intended to address patient safety practices, or services reflecting compliance with state or federal
law.
The use of CPT® II codes can ease the administrative burden of chart retrieval and review for many of the
HEDIS™ performance measures throughout the year. Use of these codes enables your office to monitor
internal performance of key measures throughout the service year. By identifying opportunities for
improvement, interventions can be implemented to improve performance.
Y0013_14_CPTIICodesEXP (4/14)
BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association
CPT® is a registered trademark of the American Medical Association. Copyright 2012 American Medical Association. All rights
reserved.
(Last Updated 12-19-12)
Providers are not required to use these codes, as they are not required for the Correct Coding Initiatives and
may not be used as a substitute for Category I codes.
Where can I find a list of CPT® II Codes?
CPT® II codes are released annually as part of the full CPT® code set and are updated semi-annually in January
and July by the AMA. The current listing of CPT® II codes can be found on the AMA Website at
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billinginsurance/cpt/about-cpt/category-ii-codes.page.
How do I bill CPT® II codes?
CPT® Category II codes are arranged according to the following categories and are comprised of four digits
followed by the letter “F”.
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Composite Measures 0001F-0015F
Patient Management 0500F-0575F
Patient History 1000F-1200F
Physical Examination 2000F-2050F
Diagnostic/Screening Processes/Results 3006F-3573F
Therapeutic, Preventive or Other Interventions 4000F-4306F
Follow-up or Other Outcomes 5005F-5100F
Patient Safety 6005F-6045F
Structural Measures 7010F-7025F
CPT® II codes describe clinical components that may be typically included in evaluation and management
services or clinical services and, therefore, do not have a relative value associated with them. Therefore, CPT®
II codes are billed with a $0.00 billable charge amount.
How can my office use CPT® II codes to track our performance on specific HEDIS™ measures?
This is not a complete list of CPT® II category codes-refer to the AMA CPT Codes & Descriptions© for a full list.
Refer to NCQA Volume 2 HEDIS1 Technical Specifications 2014 for a complete list of codes in the
administrative specifications for each measure.
1
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)
LDL-C test & level
CPT® Category II Codes
3014F
3017F
3048F, 3049F, 3050F
LDL-C test & level
3048F, 3049F, 3050F
Optic Nerve evaluation
Vaccine
Administered/reported
BMI assessed/documented
Female plan members who
broke a bone and got
screening or treatment for
osteoporosis within 6 months
Retinal Eye Exam
Urine Protein Screening
2027F
4274F
STARs Measure
Measure Description
Indicator Description
C01
C02
C03
Mammography & results
C05
C06
Breast Cancer Screen
Colorectal Screen
Cardiovascular CareCholesterol Screening
Diabetes Care-Cholesterol
Screening
Glaucoma Testing
Annual Flu Vaccine
C10
C14
Adult BMI
Osteoporosis Management
C15
C16
Diabetes Care- Eye Exam
Diabetes Care- Kidney
Disease Monitoring
Diabetes Care-Blood Sugar
Controlled
Diabetes Care-Cholesterol
Controlled
Controlling Blood Pressure
C04
C17
C18
C19
C20
Rheumatoid Arthritis
Management
3008F
3095F, 3096F, 4005F,
4019F
HgA1c test & HgA1c Level
2022F, 2024F, 2026 F, 3072F
3060F, 3061F, 3062F, 3066F,
4010F
3044F, 3045F,3046F
LDL-C test & level
3048F,3049F,3050F
Blood Pressure readings
Systolic Codes:3074F, 3075F
3077F
Diastolic Codes: 3078F, 3079F,
3080F
4187F
Patients with Rheumatoid
Arthritis who received 1 or
more prescriptions for antirheumatics
Category II
Code
2022F
2024F
2026F
2027F
3008F
3014F
3017F
3044F
3045F
3046F
3048F
3049F
3050F
3060F
3061F
3062F
3066F
3072F
3074F
3075F
3077F
3078F
3079F
3080F
3095F
3096F
4005F
4010F
4013F
4019F
4187F
4274F
Description
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented
and reviewed
7 standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist
documented and reviewed
Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results
documented and reviewed
Optic nerve head evaluation performed
Body Mass Index (BMI), documented
Screening mammography results documented and reviewed
Colorectal cancer screening results documented and reviewed
Most recent hemoglobin A1c (HbA1c) level < 7.0%
Most recent hemoglobin A1c (HbA1c) level 7.0% to 9.0%
Most recent hemoglobin A1c (HbA1c) level > 9.0%
Most recent LDL-C < 100 mg/dL
Most recent LDL-C 100 - 129 mg/dL
Most recent LDL-C greater than or equal to 130 mg/dL
Positive microalbuminuria test result documented and reviewed
Negative microalbuminuria test result documented and reviewed
Positive macroalbuminuria test result documented and reviewed
Documentation of treatment for nephropathy (eg, patient receiving dialysis, patient being treated
for ESRD, CRF, ARF, or renal insufficiency, any visit to a nephrologist)
Low risk for retinopathy (no evidence of retinopathy in the prior year)
Most recent systolic blood pressure < 130 mm Hg
Most recent systolic blood pressure 130 to 139 mm Hg
Most recent systolic blood pressure ≥ 140 mm Hg
Most recent diastolic blood pressure < 80 mm Hg
Most recent diastolic blood pressure 80 - 89 mm Hg
Most recent diastolic blood pressure ≥ 90 mm Hg
Dual-energy X-Ray Absorptiometry (DXA) results documented
Central Dual-energy X-Ray Absorptiometry (DXA) ordered
Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
Angiotensin converting enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) therapy
prescribed or currently being taken
Statin therapy prescribed or currently being taken
Documentation of receipt of counseling on exercise AND either both calcium and vitamin D use or
counseling regarding both calcium and vitamin D use
Disease modifying anti-rheumatic drug therapy prescribed, dispensed, or administered
Influenza immunization administered or previously received