FEDERAL EMPLOYEE PROGRAM INCENTIVE
FOR USING CPT CATEGORY II CODES
What is the incentive program?
As a network provider, you can earn an incentive for
sending accurate CPT Category II codes. Depending on
the measure, you can earn up to $10 for each claim that
closes HEDIS® gaps.
What is a CPT Category II code?
Category II codes make it easier to track the delivery of
quality care. The codes also simplify how performance
measures are reported and eliminate the need for chart
abstraction. Doctors and hospitals can use these codes
to report specific services that contribute to positive
outcomes and high-quality care.
Why should we use a CPT Category II code?
When you use these codes for specific services
performed during an office visit:
♦ You get more accurate care opportunity reporting,
which can increase performance in many incentive
programs in which you participate.
♦ This helps us support your care plan through more
targeted case management services.
♦ You can SAVE TIME by decreasing our need
to request member charts from you for this
same information.
BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association.
What is Federal Employee Program (FEP) coverage?
♦ FEP-compliant coverage is for the Federal Employee
workforce. This is part of the Federal Employee
Health Benefits (FEHB) program.
How do you identify FEP members?
♦ Prefixes: R
How do you use a CPT Category II code and receive
an incentive?
♦ The attached grid lists the HEDIS measures and
applicable codes that, when billed accordingly,
will result in an incentive payment.
♦ Add the CPT Category II codes when you submit
a claim for a member.
- Make sure to use the required diagnosis or
CPT codes where applicable.
♦ Add the associated incentive value to the
coordinating CPT Category II line.*
*If your organization is unable to submit the incentive values
on your claims, please email Navigator@bcbssc.com.
The incentive may change later in the year, subject to
changes NCQA makes in HEDIS specifications. BlueCross
BlueShield of South Carolina may change the incentive at
its discretion.
FEDERAL EMPLOYEE PROGRAM INCENTIVE FOR USING CPT CATEGORY II CODES
The grid below lists the HEDIS measures and applicable codes that, when billed correctly, will result in an incentive payment.

Incentive
Product HEDIS Code Measure CPT II Codes for Incentive Amount
FEP CBP Controlling High Blood Pressure 3077F1 $5
(Systolic (Value) Filed with ICD-10 DIAG CODE: I10
Value) Systolic >/= to 140 mmHg
Controlling High Blood Pressure 3075F3 $5
(Value) Filed with ICD-10 DIAG CODE: I10
Systolic 130-139 mmHg
Controlling High Blood Pressure 3074F4 $5
(Value) Filed with ICD-10 DIAG CODE: I10
Systolic < 130 mmHg
AND
CBP Controlling High Blood Pressure 3080F1 $5
(Diastolic (Value) Filed with ICD-10 DIAG CODE: I10
Value) Diastolic >/= 90 mmHg
Controlling High Blood Pressure 3079F3 $5
(Value) Filed with ICD-10 DIAG CODE: I10
Diastolic 80-89 mmHg
Controlling High Blood Pressure 3078F4 $5
(Value) Filed with ICD-10 DIAG CODE: I10
Diastolic < 80 mmHg
CDC Comprehensive Diabetes Care- 3046F1 $10
HbA1c level greater than 9.0 Filed with ICD-10 DIAG CODES: E10.9,
(Diabetic members only) E10.10-E13.9, O24.011-O24.33, O24.811-O24.83
Comprehensive Diabetes Care- 3052F2 $10
HbA1c level greater than or equal File with ICD-10 DIAG CODES: E10.9, E10.10-E13.9,
to 8.0 and less than 9.0 O24.011-O24.33, O24.811-O24.83
(Diabetic members only)
Comprehensive Diabetes Care- 3051F3 $10
HbA1c level greater than or equal Filed with ICD-10 DIAG CODES: E10.9,
to 7.0 and less than 8.0 E10.10-E13.9, O24.011-O24.33, O24.811-O24.83
(Diabetic members only)
Comprehensive Diabetes Care- 3044F4 $10
HbA1c level less than 7.0 File with ICD-10 DIAG CODES: ICD-10-E10.9,
(Diabetic members only) E10.10-E13.9, O24.011-O24.33, O24.811-O24.83
PPC Prenatal Care 0500F, 0501F, 0502F $10
File with ICD-10 DIAG CODES:
Use appropriate code from “O” family;
Z03.71-Z03.75, Z03.79, Z34.00-Z34.03,
Z34.80-Z34.83, Z34.90-Z34.93, Z36
The above incentive schedule is not a guarantee of benefits or 1
Member is non-compliant, and value may need to be
payment. Benefits are always subject to the terms and limitations addressed urgently.
of the plan.
2
Member is non-compliant, and value needs to be addressed.
3
Member is compliant, but value is above expected range.
4
Member is compliant, value is in expected range.