CPT Category II codes are supplemental tracking codes used to support quality patient care and performance management. CPT II codes are:


  • Billed in the procedure code field in the same way as CPT Category I codes.
  • Used to describe clinical components usually included in evaluation, management or clinical services.
  • Billed with a $0 billable charge amount since they are not usually associated with any relative value.


Under this new incentive program, we will reimburse contracted Medicare Advantage providers for submitting select HEDIS®-related CPT Category II codes for eligible members.

Using these CPT Category II codes for Medicare Advantage members will:


  • Help providers address clinical care opportunities.
  • Facilitate timely and accurate claims payments.


Detailed information about this program, including a list of applicable codes, will be sent to providers when the program is implemented.



75975MUPENMUB 02/19/2019

Featured In:
April 2019 Anthem Maine Provider Newsletter