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Hints for HEDIS® (and more)
Act
immediately
Effective date
Not stated in the notice
Identified
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.
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What to do
immediately · 3 steps
01Billing 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.
02Update billing system rules to prevent these modifiers from being applied to the specified CPT II codes.
03Train staff on proper use of specific codes for different HbA1c ranges and blood pressure readings to ensure accurate quality reporting.
Original notice
Hints for HEDIS® (and more)
bcbsri.com · Always check the source before changing claims.
Related changes
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