These CPT Category II codes can be billed once per member per service per calendar year.

The CPT Category II codes are: 

  • 3117F – for patients who have congestive heart failure; heart failure disease-specific structured assessment tool completed.
    • Provider completes office visit for member with heart condition. Provider completes heart failure disease specific structured assessment tool (includes lab tests, exam procedures, radiologic exam and/or results and MDM. $10.00
    • Required DX code associated for payment: I50
  • 0513F – For patients who have hypertension; elevated blood pressure plan of care.
    • Provider completes office visit for member with hypertension or hypertensive diseases. Provider completes and documents elevated blood pressure plan of care. $10.00
    • Required DX code associated for payment: I10 and I16
  • 3011F – Lipid Panel results documented and reviewed
    • Provider completes office visit. Provider documents and reviews lipid panel results in the medical record. $10.00
    • Required DX code associated for payment: I25
  • 3044F – Provider completes office visit for member with diabetes mellitus (any type).
    • Provider completes and documents HgA1C results when less than seven. $10.00
    • Required DX code associated for payment: E08, E09, E10, E11, E13
  • 3045F – For patients who have diabetes: most recent HgA1C 7-9.
    • Provider completes offie visit for member with diabetes mellitus (any ty pe) Provider completes and documents HgA1C results when 7 to 9. $10.00
    • Required DX code associated for payment: E08, E09, E10, E11, E13
  • 3046F – For patients who have diabetes: most recent Hg A1C >9.
    • Provider completes office visit for member with diabetes mellitus (any type) Provider completes and documents HgA1C results when greater than 9. $10.00
    • Required DX code associated for payment: E08, E09, E10, E11, E13

ICD 10s’ that support the service as payable: 

I50: Heart Failure, be sure to use specificity ie: Diastolic/Systolic/Combined.

I10: Essential Primary Hypertension

I16: Hypertensive Crisis

I25: Chronic Ischemic Disease, be sure to use specificity as to type

E08: Diabetes Mellitus due to underlying condition; be specific and also code underlying condition

E09: Drug or chemical induced diabetes mellitus; be specific be sure to code what drug/chemical

E10: Type 1 diabetes mellitus; be specific

E11: Type 2 diabetes mellitus; be specific

E13: Other specified diabetes mellitus; be specific

(Note from your Revenue Cycle Management partner at ebix, Inc. – We are always at the forefront of industry insights and believe this information will be of interest to you.)