CommercialJuly 31, 2024
FEP Quality Reimbursement Program for providers
The Federal Employee Program® (FEP) offers a quality reimbursement program for providers. Coding for CPT® II category codes for A1c results, blood pressure readings, and the first prenatal visit are reimbursed at $10 per code.
The program has been a success in improving HEDIS® scores and data collection. The FEP Quality Reimbursement Program for PPO providers was revised as noted below effective May 12, 2023.
Revisions to CPT II category II code requirements for $10 reimbursement:
- Only professional HCFA billing providers
- Only these six places of service codes are applicable:
- 2 — telehealth not home
- 10 — telehealth home
- 11 — office
- 12 — home
- 17 — walk-in clinic
- 20 — urgent care
- Only a specific diagnosis code that coordinates with the applicable CPT II code
Submitting the claim
Submit the CPT II code in field 24 of the HCFA 1500 with a charge of $10.
Use the applicable CPT II code, place of service code, and diagnosis code according to the information below.
Blood pressure — systolic and diastolic readings
Reimbursable DX codes: I10, I11.9, I12.9, I13.10, I15, I15.1, I15.8, I15.9, I16.0, I16.1, I16.9
3074F | Most recent systolic blood pressure less than 130 mm Hg |
3075F | Most recent systolic blood pressure 130-139 mm Hg |
3077F | Most recent systolic blood pressure greater than or equal to 140 mm Hg |
3078F | Most recent diastolic blood pressure less than 80 mm Hg |
3079F | Most recent diastolic blood pressure 80-89 mm Hg |
3080F | Most recent diastolic blood pressure greater than or equal to 90 mm Hg |
Hemoglobin A1c
Reimbursable DX codes: E10.8, E10.9, E11.8, E11.9
3044F | Most recent hemoglobin A1c (HbA1c) level less than 7.0% |
3046F | Most recent hemoglobin A1c (HbA1c) level greater than 9.0% |
3051F | Most recent hemoglobin A1c (HbA1c) level greater than or equal to 7.0% and less than 8.0% |
3052F | Most recent hemoglobin A1c (HbA1c) level greater than or equal to 8.0% and less than or equal to 9.0% |
First prenatal visit
The first prenatal visit date of service must be on the claim (field 24A HCFA 1500) with the appropriate code.
Reimbursable DX codes: Maternity-related diagnosis code
0500F | Initial prenatal care visit (report at first prenatal encounter with health care professional providing obstetrical care. Report also date of visit, and in a separate field, the date of the last menstrual period [LMP]) (Prenatal) |
0501F | Prenatal flow sheet documented in medical record by first prenatal visit (documentation includes at minimum blood pressure, weight, urine protein, uterine size, fetal heart tones, and estimated date of delivery). Report also: date of visit and, in a separate field, the date of the LMP (Note: If reporting 0501F prenatal flow sheet, it is not necessary to report 0500F Initial prenatal care visit) (Prenatal) |
For additional information about the FEP Quality Reimbursement Program, email us at FEPproviderGIC@anthem.com.
Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CM-063827-24-SRS63786, MULTI-BCBS-CM-064143-24-SRS63773
PUBLICATIONS: September 2024 Provider Newsletter
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