HEDIS® Tip Sheet

Controlling High Blood Pressure (CBP)

Line of business: BlueAlliance (Commercial) & BlueAlliance Care+ (Medicaid)

Measure Description

Percentage of Members 18-85 years of age who have been diagnosed with hypertension, whose blood pressure (BP) had been within controlled range (<140/90 mm HG) during the measurement year.

Compliant Blood Pressure

The most recent BP reading taking during the measurement year is used to determine compliance.

  • Members are compliant if the BP is <140/90 mm Hg.
  • If multiple BPs are taken on the same day, use the lowest systolic and lowest diastolic BP for that day.
  • BP readings taken by the member using a digital device are acceptable and should be documented in the medical record.  BP does not need to be collected by a PCP or specialist.

Blood Pressures excluded include those:

  • Taken in an acute inpatient setting or during an emergency department visit.
  • Taken on the same day as a diagnostic test or procedure that requires a change in diet or change in medication on or one day before the test or procedure.  An exception to this is fasting blood tests.
    • Example: A colonoscopy requires a change in diet (NPO prior to procedure) and a medication change (colonoscopy prep).
  • Taken by the member using a non-digital device such as a manual blood pressure cuff and stethoscope.
  • Documentation of BP ranges and thresholds do not meet criteria. There needs to be a distinct value for both the systolic and diastolic. 
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  • Member is not compliant if their BP is ≥ 140/90 mm Hg, if there is no BP reading during the measurement year, or if the BP reading is incomplete.
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Best Practices

  • Prepare charts prior to appointments each day verifying last BP reading.
  • Document BP at each visit.
  • Educate patients on the importance of BP control.
  • Encourage lifestyle changes such as diet, exercise, smoking cessation, and stress reduction.
  • Educate patients on taking their own blood pressure.
  • Take it twice.  Readings ≥ 140/90 mm Hg should be retaken later in the visit.
  • Ensure the proper BP cuff size is used.
  • Schedule follow-up visits for blood pressure control or medication adjustments.  If unable to control blood pressure, consider Cardiology referral.
  • For patients on blood pressure medication, discuss the importance of medication adherence.
  • Report BP readings through claims with CPT II codes.
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  • Members with end-stage renal disease (ESRD), dialysis, nephrectomy, or kidney transplant any time during the member’s history.
  • Members with a diagnosis of pregnancy any time during the measurement year. 
  • Members in hospice during the measurement year.
  • Members who died during the measurement year.
  • Member receiving palliative care during the measurement year.
  • Members 66 – 80 years of age as of December 31 of the measurement year with frailty and advanced illness.  Members must meet BOTH the frailty and advanced illness criteria to be excluded:
    • 1. At least two indicators of frailty with different dates of service during the measurement period. 
    • 2. Any of the following during the measurement year or the year prior to the measurement year:
      • At least two outpatient visits, observation visits, ED visits, telephone visits, e-visits, or virtual check-ins, nonacute inpatient encounters, or nonacute inpatient discharges on different dates of service with an advanced illness diagnosis.
      • At least one acute inpatient encounter with an advanced illness diagnosis.
      • At least one acute inpatient discharge with an advanced illness diagnosis on the discharge claim.
      • A dispensed dementia medication.
  • Members 81 years and older of age as of December 31 of the measurement year with at least two indications of frailty with different dates of service during the measurement year. 

Blood Pressure CPT® Category II Codes

Coding Disclaimer

The analysis of any medical coding question related to a measure is dependent on the measure’s technical specifications including the factual situations present related to the member, the practice, the professionals, and the medical services provided.


Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.


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