What are CPT II Codes and How Are They Used in Medical Billing

CPT II Codes / category 2CPT Category II codes are tracking codes which facilitate data collection for the purposes of performance measurement. The tracking codes are adopted and reviewed by the Performance Measures Advisory Group (PMAG). The PMAG is made up of experts in performance measurement from organizations including the AMA, NCQA, CMS, AHRQ and JCAHO. CPT II codes are released annually as part of the full CPT code set and are updated semi-annually in January and July by the AMA. The current listing of CPT II codes can be found on the AMA Web site. Not only can using CPT II codes ease the administrative burden of chart review for many HEDISTMi performance measures, use of these codes enables organizations to monitor internal performance for key measures throughout the year, rather than once per year as measured by health plans and Pay for Performance. By identifying opportunities for improvement, interventions can be implemented to improve performance during the service year. In addition, these codes can be used to participate in Medicare's PQRS program.  Special rules apply to the use of CPT II codes for the Medicare PQRS (formerly PQRI) bonus program. See the CMS website for details. Some of the other benefits of utilizing the CPT II codes:

  • When procedure and diagnosis codes are used for these specific services performed at an office visit, it decreases the need to request a member’s charts for this same information;
  • Capturing this data helps to drive HEDIS performance improvements. When these codes are used, gaps in care are more quickly identified as closed which drives direct Star Ratings improvements and can increase performance in any incentives in which you participate; and
  • Coding for these services provides access to more accurate medical data which can help our efforts to support your care plan through more targeted case management services.

CPT Category II codes are arranged according to the following categories and are comprised of four digits followed by the letter “F”.

  • Composite Measures 0001F – 0015F
  • Patient Management 0500F – 0575F
  • Patient History 1000F – 1220F
  • Physical Examination 2000F – 2050F
  • Diagnostic/Screening Processes/ Results 3006F – 3573F
  • Therapeutic, Preventive, or Other Interventions 4000F – 4306F
  • Follow-Up or Other Outcomes 5005F – 5100F
  • Patient Safety 6005F – 6045F
  • Structural Measures 7010F – 7025F

CPT II codes are billed in the procedure code field, just as CPT Category I codes are billed. CPT II codes describe clinical components usually included in evaluation and management or clinical services and are not associated with any relative value. Therefore, CPT II codes are billed with a $0.00 billable charge amount.

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