CPT Category II Codes

CPT Category II Codes are tracking codes which facilitate data collection related to quality and performance measurement. They allow providers to report services and/or values based on nationally recognized, evidence based performance guidelines for improving quality of patient care.

CPT Category II Codes are billed in the procedure code field, just as CPT Category I codes are billed. However, Category II Codes are not reimbursable and are billed with a $0 charge amount.

Use of these codes may ease the administrative burden of chart review for many NCQA HEDIS® performance measures and increase quality performance for your practice.

CPT II codes will still be important to use after the ICD-10 transition as in many cases they capture data that ICD-10 codes do not.

Below are some frequently used CPT II codes that your practice may want to use when billing. If you would like to see a full list of CPT Category II Codes refer to the AMA CPT Codes and Descriptions© book or list on the American Medical Association website.

Condition and/or Metric CPT II Code(s)
Adult BMI 3008F Body Mass Index (BMI) documented
*use ICD 9 or ICD 10 codes to indicate specific BMI scores
Diabetes: HbA1c Testing 3044F Most recent HbA1c level < 7.0%
3045F Most recent HbA1c level 7.0 – 9.0%
3046F Most recent HbA1c level >9.0%
Diabetes: Retinal Eye Exam Performed 2022F Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed
2024F 7 standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed
2026F Eye imaging validated to match diagnosis from 7 standard field stereoscopic photos results documented and reviewed
3072F Low risk for retinopathy (no evidence of retinopathy in the prior year)
Diabetes: LDL-C Screening
Diabetes: LDL-C Control (< 100 mg/dL) Hyperlipidemia
3048F Most recent LDL-C < 100 mg/Dl
3049F Most recent LDL-C 100-129 mg/dL
3050F Most recent LDL-C ≥ 130 mg/dL
Diabetes: Medical Attention for Nephropathy 3060F Positive microalbuminuria test result documented and reviewed
3061F Negative microalbuminuria test result documented and reviewed
3062F Positive macroalbuminuria test result documented and reviewed
3066F Documentation of treatment for nephropathy (patient receiving dialysis, patient being treated for ESRD, CKD, ARF, or renal insufficiency, any visit to a nephrologist)
4009F ACE inhibitor or ARB therapy prescribed
Hypertension: Blood Pressure Controlled 3074F Most recent systolic blood pressure < 130 mm Hg
3075F Most recent systolic blood pressure 130-139 mm Hg
3077F Most recent systolic blood pressure > 140 mm Hg
3078F Most recent diastolic blood pressure < 80 mm Hg
3079F Most recent diastolic blood pressure 80-89 mm Hg
3080F Most recent diastolic blood pressure >90
Breast Cancer Screening 3014F Screening mammography results documented and reviewed
Colorectal Cancer Screening 3017F Colorectal cancer screening results documented and reviewed
Cervical Cancer Screening 3015F Cervical cancer screening results documented and reviewed
Prenatal/Post-partum care 0500F Initial prenatal care visit
0501F Prenatal flow sheet documented in medical record by first prenatal visit
0503F Postpartum care visit
Tobacco Use 1034F Current tobacco smoker
1035F Current smokeless tobacco user
1036F Current tobacco non-user
4000F Tobacco use cessation intervention, counseling
4001F Tobacco use cessation intervention, pharmacologic therapy
Immunizations 1030F Influenza immunization status assessed
4274F Influenza immunization administered or previously received
4037F Influenza immunization ordered or administered
1022F Pneumococcus immunization status assessed
4040F Pneumococcal vaccine administered or previously received
Rheumatoid Arthritis Management 4187F 1 or more DMARD dispensed, prescribed or administered
Use of Spirometry Testing in the Assessment and Diagnosis of COPD 3023F Spirometry results documented and reviewed
3025F Spirometry test results demonstrate FEV/FVC less than 70% with COPD symptoms (dyspnea, cough/sputum, wheezing)
3027F Spirometry test results demonstrate FEV/FVC greater than or equal to 70% or patient does not have COPD symptoms
3023F Spirometry results documented and reviewed
3025F Spirometry test results demonstrate FEV/FVC less than 70% with COPD symptoms (dyspnea, cough/sputum, wheezing)
3027F Spirometry test results demonstrate FEV/FVC greater than or equal to 70% or patient does not have COPD symptoms
Fall Risk Assessment 0518F Falls plan of care documented
1100F Patient screened for fall risk: 2 or more falls in last year or fall with injury in last year
1101F Patient screen for fall risk: no falls in last year or 1 fall with no injury in last year
Osteoporosis Management for Women with Fracture 4005F Pharmacologic therapy (other than vitamins/minerals) for osteoporosis prescribed
3095F Central Dual-energy X-Ray Absorptiometry (DXA) results documented
Care for Older Adults 1157F Advance care plan or similar legal document present in the medical record
1158F Advance care planning discussion documented in the medical record
1123F Advance Care Planning discussed and documented; advance care plan or surrogate decision maker documented in the medical record
1160F Review of all medications by a prescribing practitioner or clinical pharmacist (such as, prescriptions, OTCs, herbal therapies and supplements) documented in the medical record
1170F Functional status assessed
0521F Plan of care to address pain documented
1125F Pain severity quantified; pain present
1126F Pain severity quantified; no pain present


If you have questions about CPT II Codes and how to implement them in your practice, please contact:

Jennifer Castore, MPH
Quality Management Coordinator
614-546-4257
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OR

Lori Miller, RN, BSN
Quality Manager
614-546-3778
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