As an eyecare provider, you are familiar with CPT® Category II codes (CPTII codes). These codes are supplemental tracking codes that can be used for performance measurement, supporting programs like Medicare’s Merit-based Incentive Payments System (MIPS), Healthcare Effectiveness Data and Information Set (HEDIS®), and Star Ratings.1 While CPTII codes are not required for reimbursement, they CAN benefit your practice and your patients. Here’s how:
Reduced Administrative Burden for Your Practice
By using CPTII codes, you can help reduce the need for chart reviews and record abstraction. 1 Office staff can spend less time pulling patient records and more time completing other responsibilities within your practice.
More Accurate Medical Data
CPT II codes are more specific than CPT I codes and provide more detailed and accurate information about services and test results. This can help providers work more efficiently and effectively in the best interest of each patient.
Better Tracking and Management of Patient Care Needs
CPT II codes can help identify and close gaps in care, thus improving continuity of care for your patients. They can also help track member screenings to avoid unnecessary reminders, saving your practice time and money while avoiding patient abrasion.
Help Meet Performance Measures
CPT II codes can help Superior Vision® and Davis Vision® health plan clients meet quality measurement requirements and ensure patients are receiving high-quality healthcare.
By including the following diabetic eye exam CPTII codes on your claims*, you underline the importance of annual eye exams for your patients and promote the valuable role of optometry in patient health care:
| Use these codes for Diabetic Patients WITH Evidence of Retinopathy | |
| 2022F | Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed |
| 2024F | Seven standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed |
| 2026F | Eye imaging validated to match diagnosis from seven standard field stereoscopic retinal photos results documented and reviewed |
| Use these codes for Diabetic Patients WITHOUT Evidence of Retinopathy | |
| 2023F | Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed |
| 2025F | Seven standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed |
| 2033F | Eye imaging validated to match diagnosis from seven standard field stereoscopic retinal photos results documented and reviewed |
| Use this code for Diabetic Patients who had no evidence of retinopathy in the prior year | |
| 3072F | Low risk for retinopathy (no evidence of retinopathy in the prior year), photos results documented and reviewed |
* CPT Category II codes are billed the same way your office bills for regular CPT codes and are placed in the same location on the claim form. CPT® is a registered trademark of the American Medical Association. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Source: American Medical Association, “Criteria for CPT® Category II codes”
