All PlansBilling CodesMedium impact
Hints for HEDIS
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, Endocrinology +1 more·Physician
Effective date
Jan 1, 2020
We identified it
Jun 19, 2026
Summary
AMA updated CPT Category II codes for HEDIS quality reporting for diabetes care. Several eye exam codes were revised, new codes were added to distinguish between presence/absence of retinopathy, and A1c control codes were updated with one deletion and two new additions.
Action Required
Immediately: Billing team must update Category II code usage for HEDIS quality reporting. Replace expired code 3045F with new codes 3051F or 3052F for A1c reporting. Use new eye exam codes (2023F, 2025F, 2033F) to distinguish between patients with and without retinopathy evidence. Update billing system and provider documentation templates to reflect revised code requirements for quality measures.