CommercialDocumentationMedium impact
Hints for HEDIS® (and more)
Blue Cross Blue Shield of Rhode Island·RI · Ophthalmology, Optometry, Family Medicine +2 more·Physician
Effective date
Jun 1, 2019
We identified it
Jun 20, 2026
Summary
BCBSRI has released updated guidance on HEDIS quality measures for ophthalmology practices, specifically focusing on the Comprehensive Diabetes Care measure that requires retinal eye exams. The policy clarifies specific CPT Category II codes that can be used to document diabetic eye exams and emphasizes the importance of proper claims submission to validate HEDIS measures.
Action Required
Billing team should ensure ophthalmology practices are using the correct CPT Category II codes (2022F, 2024F, 2026F, 3072F) when documenting diabetic retinal exams. Verify that claims include appropriate diabetes ICD-10 codes paired with eye exam codes (920xx) or E&M codes (992xx) to support HEDIS quality measure reporting. Contact Quality Concierge Team at QualityHEDIS@bcbsri.org or (401) 459-1005 for questions about gap closure reporting.