CPT Category II Codes
Need help closing Care Gaps?
Did you know that Current Procedural Terminology (CPT) Category II codes can streamline your administrative processes and close gaps in care.
These codes, when used in conjunction with appropriate codes for the services provided during office visits codes or procedure codes, are used to track performance by giving measurable data for evaluating quality of care. CPT Category II codes will not replace the regular CPT (Category I) codes that providers use for services provided. CPT Category II codes are used in conjunction with these codes. The use of the CPT Category II codes is optional and is used for reporting purposes only, therefore they do not have any values assigned to them on the fee schedule.
Why use CPT Category II codes?
Using CPT Category II codes allows the tracking of performance of various measures during the year. These will assist in finding opportunities for improvement and implement interventions in a timely manner to improve health outcomes for our members. Identifying these members within your facility who might need care management or a change in their treatment plan to reach their desired health outcomes.
Using these CPT Category II codes for performance measures like Healthcare Effectiveness Data and Information Set (HEDIS®), help reduce the need for medical records for chart review and potentially reduce administrative burdens on the providers or healthcare professionals.
Guidance of Billing CPT Category II codes
Reporting CPT Category II codes is optional and is used for reporting purposes only. CPT Category II codes are not to replace CPT Category I codes or CPT Category III codes. CPT Category II codes are billed with a $.00 charge or a $.01 charge. CPT Category II codes will be billed as non-covered codes that are processed into the HEDIS® measure. CPT Category II codes will reflect on patients EOB’s along with anything else submitted by the provider.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
