Medicare AdvantageDocumentationMedium impact
Hints for HEDIS® (and more)
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, Endocrinology +3 more·Physician
Effective date
Apr 1, 2021
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island has released updated HEDIS quality measure guidelines for comprehensive diabetes care, including specific CPT Category II codes for eye exams, A1c testing, and nephropathy screening. This provides billing teams with detailed coding requirements to support quality measure reporting for diabetic patients.
Action Required
Immediately: Billing team should update encounter forms and EMR templates to include the specified CPT Category II codes for diabetic care quality reporting. Train providers on proper use of A1c result codes (3044F, 3051F, 3052F, 3046F), diabetic eye exam codes (2022F-2026F, 2033F, 3072F), and nephropathy screening codes (3060F-3062F, 3066F, 4010F) for all diabetic patients aged 18-75. Ensure lab feeds are properly configured to capture A1c values and verify gaps in care are closing appropriately in quality reporting.