Medicare AdvantageBilling CodesMedium impact
Hints for HEDIS® (and more)
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, Endocrinology·Physician
We identified it
Jun 20, 2026
Summary
BCBSRI has updated their HEDIS quality measure guidelines for Comprehensive Diabetes Care, providing specific CPT Category II codes for reporting HbA1c results, nephropathy screening, blood pressure control, and eye exams. The policy emphasizes proper coding without modifiers 1P, 2P, 3P, or 8P which would exclude codes from care gap calculations.
Action Required
Immediately: Billing team must ensure all CPT Category II codes for diabetes care quality measures (HbA1c testing, nephropathy screening, blood pressure monitoring, and eye exams) are submitted WITHOUT modifiers 1P, 2P, 3P, or 8P. Update billing system rules to prevent these modifiers from being applied to the specified CPT II codes. Train staff on proper use of specific codes for different HbA1c ranges and blood pressure readings to ensure accurate quality reporting.