AB2026-07-002 Quality information

By July 1, 2026: (1) Billing 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. (2) Update 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. (3) Coding 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. (4) Quality team must implement Theon™ for gap management and Action Reports to track open CBP gaps. (5) Providers 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. (6) Professional 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. (7) Contact Population Health Consultant or Provider Engagement Consultant (NPI/Tax ID lookup at capbluecross.com/wps/portal/cap/provider/pec-look-up) for questions. Failure to properly code BP compliance and exclusions will result in increased medical record requests, inaccurate HEDIS reporting, and potential quality measure penalties.