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December 2014
CPT Category II codes, V codes help you monitor performance on key measures
It’s important to use available Current Procedural Terminology Category II and V codes to help you — and Blue Cross — monitor performance on key measures. Here’s what you need to know about these codes.
What are CPT Category II and V codes?
CPT Category II codes and V codes are tracking codes used to collect clinical data that help measure health care performance. CPT Category II codes describe components usually included in the evaluation and management of clinical services, such as test results or blood pressure, and are billed in the procedure code field just like CPT Category I codes. Alternatively, V codes are diagnosis codes which in general describe screening exam components included in the evaluation and management of clinical services.
Why should my practice use CPT Category II and V codes?
The use of CPT Category II and V codes enables your organization to monitor internal performance for key measures and eases the administrative burden of chart review for many HEDIS® measures. You can then identify opportunities for improvement and address them throughout the year. Use of available CPT Category II and V codes also will enable us to measure and better manage the care Blues members receive, which helps meet key HEDIS and Centers for Medicare & Medicaid Services star measures. Using CPT codes will also decrease the amount of information Blue Cross may need to request in determining HEDIS performance.
When should my practice begin using CPT Category II and V codes?
Please start using the available CPT Category II and V codes on professional claims immediately. Doing so will help better track the management of members’ health risks and improve physician organization and provider performance on initiatives, such as evidence-based care tracking, Provider Recognition Program and Patient-Centered Medical Home designation.
What do I need to know about exclusions?
Members who have certain medical conditions may be excluded from a specific measure. Health care providers need to code for these exclusions to ensure that their performance on a measure is not affected by a member not receiving a specific service.
The following chart includes select HEDIS measures, descriptions and CPT Category II or V codes. For additional measures and reporting codes, refer to HEDIS Technical Specifications 2015, Volume 2.
HEDIS measure |
Descriptor |
CPT II codes or V codes |
Exclusions |
Comprehensive Diabetes Care |
A1C test and level |
*3044F
*3045F
*3046F |
Identify members who have not had diagnosis of diabetes and meet the following:
– Polycystic ovarian disease any time in patient’s history through Dec 31 or current year.
– Gestational diabetes in current year or year prior
– Steroid-induced diabetes in current year or year prior
For HbA1C control < 7%, the following are excluded: Members who are >65 years during current year and those with dementia; late-stage diabetes complications; including blindness; chronic kidney disease; end-stage renal disease; history of lower extremity amputation; cardiac disease, including congestive heart failure, thoracic aortic aneurysm, cardiomyopathy, atherosclerotic cardiovascular disease, myocardial infarction, coronary artery bypass graft, or percutaneous coronary intervention |
Comprehensive Diabetes Care |
Eye exam |
*3072F
*2022F, *2024F, *2026F |
Comprehensive Diabetes Care |
Nephropathy monitoring |
*3060F
*3061F
*3062F
*3066F
*4010F |
Comprehensive Diabetes Care |
Blood pressure readings |
*3074F and *3075F
*3077F
*3078F
*3079F
*3080F |
Controlling high blood pressure Medical record review only. Coding exclusions can remove patient from measure. |
Blood pressure readings |
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– End stage renal disease or kidney transplant on or prior to Dec 31 of current year.
– Pregnancy
– Non-acute inpatient admission in measurement year |
Adult BMI
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BMI assessed and documented in conjunction with height and weight |
V85.0 - V85.45 for adults
V85.0 |
BMI less than 19 |
V85.1 |
BMI between 19-24 |
V85.21 |
BMI 25.0-25.9 |
V85.22 |
BMI 26.0-26.9 |
V85.23 |
BMI 27.0-27.9 |
V85.24 |
BMI 28.0-28.9 |
V85.25 |
BMI 29.0-29.9 |
V85.30 |
BMI 30.0-30.9 |
V85.31 |
BMI 31.0-31.9 |
V85.32 |
BMI 32.0-32.9 |
V85.33 |
BMI 33.0-33.9 |
V85.34 |
BMI 34.0-34.9 |
V85.35 |
BMI 35.0-35.9 |
V85.36 |
BMI 36.0-36.9 |
V85.37 |
BMI 37.0-37.9 |
V85.38 |
BMI 38.0-38.9 |
V85.39 |
BMI 39.0-39.9 |
V85.41 |
BMI 40.0-44.9 |
V85.42 |
BMI 45.0-49.9 |
V85.43 |
BMI 50.0-59.9 |
V85.44 |
BMI 60.0-69.9 |
V85.45 |
BMI 70 and over |
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Pregnancy in current year or year prior |
Pediatric BMI and counseling |
BMI percentile assessed and documented, counseling on physical activity and nutrition |
BMI %= V85.51- V85.54 for children
V85.51 |
BMI <5% |
V85.52 |
BMI 5% - <85% |
V85.53 |
BMI 85% - <95% |
V85.54 |
BMI >= 95% |
Physical activity= V65.41
Nutrition= V65.3 |
Pregnancy in current year |
Cervical cancer screening |
Cervical cytology with or without HPV screening |
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Hysterectomy with no residual cervix
Absence of cervix=
V88.01 or
V 88.03 |
Prenatal and postpartum |
Timeliness of prenatal and postpartum care |
V24.0- V24.2 – Postpartum
V72.31 – Routine GYN (PP)
V72.32 – Pap smear (PP)
*0503F – Postpartum
*0500F, *0501F and *0502F |
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HEDIS is a registered trademark of the National Committee for Quality Assurance.
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