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Hints for HEDIS® (and more)
Act
immediately
Effective date
Jun 1, 2020
Identified
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.
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What to do
immediately · 3 steps
01Billing 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.
02Update encounter forms and EMR templates to include these quality measure codes.
03Contact Quality Concierge Team at QualityHEDIS@bcbsri.org or (401) 459-1005 for questions about gap closure reporting.
Original notice
Hints for HEDIS® (and more)
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →CPT Category II CodesMediumNo effective date · PhysicianHints for HEDIS® (and more)LowEffective Jan 1, 2019 · PhysicianHints for HEDIS® (and more)MediumEffective Feb 1, 2019 · PhysicianHints for HEDIS® (and more)MediumEffective Apr 1, 2019 · PhysicianBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list