Do you have time for a Quality Minute on CPT II codes?

This is another article in our ongoing series of quick tips designed to be read in 60 seconds or less, and provide your practice with information about performance in key areas.

CPT II codes

Here are some billing tips when submitting CPT II codes for office, lab or facility visits:

• The use of CPT category II codes:
• Decreases the administrative burden on practitioners and staff
• Decreases requests for members’ medical records for review
• Impacts performance in many HEDIS^® quality measures, including controlling high blood pressure, eye exams for patients with diabetes, glycemic status assessment for patients with diabetes, and transitions of care: medication reconciliation

• Automating your electronic medical records to add CPT category II codes to claims is the most efficient way to close quality gaps. 

• When billed on a claim, the CPT category II code is added to the procedure code field with a $0 charge. If your billing system drops nonrevenue-generating codes, enter $0.01. Exception: Medicare Advantage plans reimburse $35 for *1111F.

• CPT category II codes can be billed alone if reported outside of a visit, using the date the service was performed.

• If the patient has a visit and a CPT category II service was reviewed during the visit:
• The date of the visit should be entered for the visit service code date of service.
• The date the CPT category II service was performed should be entered for the CPT category II code date of service.

For more information, see the 2024 NPI Series – CPT Category II Codes (PDF) . You can also find this information by:

1. Logging in to our provider portal (availity.com).**
2. Clicking on Payer Spaces on the menu bar, and then clicking on the BCBSM and BCN logo.
3. Clicking on the Resources tab.
4. Selecting Secure Provider Resources (Blue Cross and BCN).
5. Selecting Member Care on the menu bar and then clicking on Clinical Quality and Clinical Quality Overview. The PDF is under the Network Performance Improvement section.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance.