Reimbursement for select HEDIS related CPT II codes for Medicare Advantage members coming soon

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.

 

ABSCARE-0006-19

75975MUPENMUB 02/19/2019