Medicare AdvantageDocumentationHigh impact
Hints for HEDIS® (and more)
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, Endocrinology +3 more·Physician
Effective date
Oct 1, 2021
We identified it
Jun 19, 2026
Summary
This policy provides comprehensive guidance for HEDIS Comprehensive Diabetes Care quality measures, detailing specific HbA1c targets (≤9% for Medicare, ≤8% for Commercial), retinal eye exam requirements, and nephropathy screening documentation. The policy includes extensive CPT Category II codes and ICD-10 codes that must be used for proper quality measure reporting.
Action Required
Immediately: Billing team must ensure all diabetes care visits include appropriate CPT Category II codes (3044F-3052F for HbA1c, 2022F-2033F for retinal exams, 3066F-4010F for nephropathy) to support HEDIS quality reporting. Update encounter forms to remind providers to document HbA1c results, retinal eye exams, and nephropathy screening. Train staff on different HbA1c targets: ≤9% for Medicare patients, ≤8% for Commercial patients. Failure to use proper Category II codes will impact quality measure compliance and potential bonus payments.