Participating in HEDIS Reporting

Healthcare Effectiveness Data and Information Set (HEDIS) reporting is used to measure how well a health plan performs in areas of quality of care, access to care, and member satisfaction with the plan itself. Eyecare providers play an important role in HEDIS reporting because dilated eye exams are covered under HEDIS reporting requirements. Health plans report on this service as part of their HEDIS reporting.

HEDIS reporting relies on CPT Category II codes, which are tracking codes that may be added to claims to facilitate case reporting. CPT Category II codes are billed at a zero dollar ($0.00) amount. Many eyecare providers have been exposed to CPT Category II codes through such programs as MIPS Quality and PQRS.

The following topics describe how to document CPT Category II codes on non-Medicare exams and how to add the Category II CPT codes to non-Medicare claims. Refer to the topics that correspond to your electronic health record and practice management systems.

Identifying CPT Category II Codes for HEDIS Reporting

Documenting Category II CPT Codes in Exams

Adding Category II Codes to Orders and Claims