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AB2026-07-002 Quality information
Act
by Jul 1, 2026
Effective date
Jul 1, 2026
Identified
Jul 1, 2026
Summary
Capital Blue Cross has issued an updated quality information bulletin (AB2026-07-002) effective July 1, 2026, establishing new HEDIS measurement requirements for Controlling High Blood Pressure (CBP), clarifying advanced illness and frailty exclusion criteria, and introducing a new Annual Wellness Visit checklist for Medicare providers. Billing teams must implement proper coding for BP compliance tracking, ensure accurate documentation of exclusions, and incorporate the new AWV checklist into workflow to avoid gaps in HEDIS reporting.
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What to do
by Jul 1, 2026 · 7 steps
01Billing team must update billing system to ensure CPT II codes 3074F, 3075F (compliant systolic/diastolic) and 3077F, 3080F (non-compliant) are billed appropriately based on BP readings documented during measurement year.
02Update encounter forms and EMR templates to require providers document distinct numeric results for BOTH systolic and diastolic readings; digital device BP readings from telehealth/telephone visits are acceptable, but non-digital devices are excluded.
03Coding staff must ensure medical record documentation includes: (a) for advanced illness exclusions—diagnosis billed on two different dates of service OR dementia medication prescription, (b) for frailty exclusions—at least two frailty indicators (devices, diagnoses, home health services, or symptoms) billed on different dates of service.
04Quality team must implement Theon™ for gap management and Action Reports to track open CBP gaps.
05Providers must exclude members meeting criteria: age 66+ in long-term institutions with advanced illness/frailty, on hospice/palliative care, with ESRD/dialysis/kidney transplant, or diagnosed with pregnancy during measurement year.
06Professional providers must incorporate the new Annual Wellness Visit (AWV) Checklist into routine Medicare AWV workflow as a one-page reference for documenting cancer screenings, social needs screenings, and appropriate blood tests.
07Contact Population Health Consultant or Provider Engagement Consultant (NPI/Tax ID lookup at capbluecross.com/wps/portal/cap/provider/pec-look-up) for questions.
If missed: Failure to properly code BP compliance and exclusions will result in increased medical record requests, inaccurate HEDIS reporting, and potential quality measure penalties.
Codes mentioned
I10
Original notice
AB2026-07-002 Quality information
capbluecross.com · Always check the source before changing claims.