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Hints for HEDIS® (and more)
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, Endocrinology +4 more·Physician
Effective date
Jun 1, 2020
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island has updated their HEDIS quality measure reference guide with specific CPT Category II codes for documenting care gap closures. The policy provides billing codes for blood pressure control, diabetes management (A1c, eye exams, nephropathy), and medication reconciliation to improve quality reporting and member care coordination.
Action Required
Immediately: Billing team should encourage providers to use the specified CPT Category II codes when documenting blood pressure management, diabetes care (A1c levels, eye exams, nephropathy screening), and post-discharge medication reconciliation. Update encounter forms and EMR templates to include these quality measure codes. Contact Quality Concierge Team at QualityHEDIS@bcbsri.org or (401) 459-1005 for questions about gap closure reporting.