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February 2020
We’re announcing HEDIS quality measure changes
In October, the National Committee for Quality Assurance released value set changes for the following HEDIS® quality measures:
- Comprehensive Diabetes Care, or CDC: HbA1c control
- Comprehensive Diabetes Care, or CDC: Retinal eye exam
- Controlling High Blood Pressure, or CBP
Important changes
CDC: HbA1c: Two new procedure codes (*3051F and *3052F) were added to better capture HbA1c levels. Code *3045F (HbA1c level 7.0-9.0%) should no longer be used. When conducting an HbA1c test in your office, submit the distinct numeric results on the HbA1c claim with the appropriate procedure code:
| Procedure code* |
Most recent HbA1c level |
| 3044F |
<7% |
| 3046F |
>9% |
| 3051F |
>7% and <8% |
| 3052F |
>8% and <9% |
CDC: Retinal eye exam: One new procedure code (*2023F) was added to capture negative eye exam results, which result in two years of compliance for HEDIS®. The code descriptor for *2022F was also revised to indicate its use for a positive eye exam. When results are received from an eye care professional, submit the results on a $0.01 claim with the appropriate procedure code:
| Procedure code* |
Retinal eye exam findings |
| 2022F |
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy |
| 2023F |
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy |
| 3072F |
Low risk for retinopathy (no evidence of retinopathy in the prior year) |
CBP: The measure has been revised to allow for administrative closure through claims. Submit blood pressure procedure codes for each office visit:
| Procedure code* |
Most recent systolic blood pressure |
| 3074F |
<130 mm Hg |
| 3075F |
130-139 mm Hg |
| 3077F |
≥ 140 mm Hg |
| Procedure code* |
Most recent diastolic blood pressure |
| 3078F |
<80 mm Hg |
| 3079F |
80-89 mm Hg |
| 3080F |
≥ 90 mm Hg |
Learn more about the CDC and CBP measures, including information about who’s included in the measures, exclusions and useful tips, by accessing the following tip sheets:
HEDIS® is a registered trademark of the National Committee for Quality Assurance. |
