HEDIS® Tip Sheet

Controlling High Blood Pressure (CBP)

Measure Description

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

To be included in the denominator, members must meet the following criteria:

  • Members must have at least two outpatient visits, telephone visits, or e-visits on different dates of service with a diagnosis of hypertension on or between January 1st of the year prior to the measurement period and June 30th of the measurement period.

Compliant Blood Pressure

The most recent BP reading taken 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.

Exclude Blood Pressures:

  • 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.
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Notes

  • A specific value for both the systolic and diastolic BP must be documented. Documentation of BP ranges or thresholds do not meet criteria.
  • Members are not compliant if:
    • BP is ≥ 140/90 mm Hg
    • BP reading is missing or incomplete
  • Data for screening may come from supplemental data sources or CPT Category II codes.
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Best Practices

  • Ensure all data elements are documented in structured fields within the EMR that can be extracted for supplemental data submission. For example, blood pressure readings should be entered in designated vitals or flow sheet fields rather than solely within the narrative portion of the medical record, as supplemental data extraction may not capture information documented only in free-text notes.
  • Review patient charts prior to appointments and identify the most recent blood pressure reading to support proactive management.
  • Document both the systolic and diastolic blood pressure readings at every visit.
  • Educate patients on the importance of maintaining blood pressure within the recommended range to reduce the risk of cardiovascular disease, stroke, and other complications.
  • Encourage lifestyle modifications, including a heart healthy diet, regular physical activity, smoking cessation, weight management, and stress reduction.
  • Teach patients how to accurately monitor and record their blood pressure at home and encourage them to bring readings to follow up appointments.
  • Repeat elevated blood pressure readings during the visit. Readings of ≥140/90 mm Hg should be reassessed later in the encounter to confirm accuracy.
  • Ensure the appropriate cuff size is used and proper blood pressure measurement techniques are followed.
  • Schedule timely follow up visits for blood pressure monitoring, medication adjustments, and ongoing management.
  • For patients prescribed antihypertensive medications, reinforce the importance of medication adherence and discuss potential barriers to taking medications as directed.
  • Utilize team based care approaches, when available, to provide ongoing education, monitoring, and support for patients with hypertension.
  • Consider leveraging EMR capabilities to capture and submit appropriate Category II CPT codes, when available, to support quality measure reporting and improve documentation of blood pressure control.
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Exclusions

  • Members with end-stage renal disease (ESRD) or with a procedure that indicates 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 or receiving palliative care during the measurement year.
  • Members who died 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:
    • At least two indicators of frailty with different dates of service during the measurement period. 
    • 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.
  • Members who had a nonacute inpatient admission during the measurement period

Blood Pressure CPT® Category II Codes



Coding and Benefits Disclaimer

Providers and organizations must submit accurate and complete data in accordance with all billing, coding, and medical policy requirements. HEDIS guidance does not override official coding standards or guarantee reimbursement, as coverage is subject to applicable medical/coding policy and member-specific benefits.

Questions

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

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Updated 8/28/2026