CommercialDocumentationMedium impact
Optimizing Care Coordination and CPT II Codes (HEDIS Measures AMR, CBP, GSD, SPC)
Florida Blue·FL · Family Medicine, Internal Medicine, Cardiology +3 more·Coding
Effective date
Aug 1, 2025
We identified it
Jun 16, 2026
Summary
Blue Cross Blue Shield Federal Employee Program has issued new guidance for optimizing care coordination through CPT II codes for four specific HEDIS quality measures: Asthma Medication Ratio (AMR), Controlling Blood Pressure (CBP), Glycemic Status Assessment for Diabetes (GSD), and Statin Medication Adherence (SPC). Providers must begin using specific CPT II codes when documenting blood pressure readings, HbA1c results, and statin intolerance to improve quality reporting and reduce chart review requests.
Action Required
By August 2025: Billing team must update encounter forms and EMR templates to include CPT II codes for blood pressure readings (3074F-3080F), diabetes HbA1c results (3044F, 3046F, 3051F, 3052F), and prenatal/postpartum care (0500F-0503F). Train providers to document lowest same-day BP readings and last A1c of the year with appropriate CPT II codes. Update billing system to include SNOMED codes for statin intolerance documentation. These codes help reduce HEDIS chart review burden and improve quality reporting.