Posted in EmblemHealth NY, HEDIS Measures, NY Providers, Payer Updates

Hedis Measure: Controlling Blood Pressure Controlling Blood Pressure

Are you a provider that participates in reporting HEDIS measures? Then this blog post is for you!

What is this measure: the measure assesses if adults (18-85) with hypertension have their blood pressure adequately controlled, below 140/90 mm Hg. and below 130/80 Hg.

Documentation Requirements:

1. Adults 18-85 with a hypertension diagnosis. 

2. At least two visits during the measurement period with hypertension diagnoses, with a controlled reading occurring on or after the second diagnosis. 

3. Don’t forget to remove the members fhat were identified to have a nonacute inpatient admission during the measurement period.

4. Using remote devices to meet this HEDIS measure- some payers cover remote blood pressure devices ex. Emblem Health- place an order for the remote device through an In network DME provider- the cost cannot exceed $40. For this measure the patient read reading does not meet the medical criteria- the information should be transmitted to the provider from the device.


Coding: peoper codes to report the blood pressure measurements

  1. Systolic Blood Pressure CPT II:
    3074F – blood pressure less than 130 mmHg
    3075F – blood pressure 130-139 mmHg
    3077F – blood pressure greater than or equal to 140 mmHg
  2. Diastolic Blood Pressure CPT II:
    3078F – blood pressure less than 80 mmHg
    3079F – blood pressure 80‐89 mmHg
    3080F – blood pressure greater than or equal to 90

Find this information useful? Follow my blog for more information #HEDIS #medicalcoding #compliance


Posted in #reimbursement, #unitedhealthcare, NY Providers, Payers and CPT reinbursement, Training

NYS UHC Community Plan OBGYN required codes

Are you an OBGYN that practices in NYS and accepts UHC Community Plan? Then this blog post is for you.

As per UHC Community Health Plan announcement the claims need to be submitted with the additional codes:

0500F – Initial prenatal visit
0502F – Subsequent prenatal visit
0503F – Postpartum visit 

These codes are not reimbursed separately and are only used for HEDIS reporting.

Please do not forget to bill the proper OBGYN codes (global, etc) in order to get reimbursement.


Find this blog post useful? Follow my blog for more current medical billing, coding and reimbursement updates.


Posted in BCBS (Various States), NY Providers, Training, Updates

HEDIS Measure: Update Colorectal Cancer Screening for 2022

Are you a primary care physician and is reporting HEDIS measures? Then this following blog post is for you.


In this blog post we will discuss the changes/updates that NCQA just released for HEDIS Colorectal Cancer Screening Measure.

Measure Description: Measures the percentage of members 45 to 75 years of age who had appropriate screening for rectal cancer. The Medicaid product was added to the administrative data collection method for this measure and the age range was changed to 45 to 75 years of age.

In order to meet this measure your patients need to fall in ANY of the following criteria:

  • Fecal occult blood test during the measurement year
  • Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year
  • Colonoscopy during the measurement year or the nine years prior to the measurement year
  • CT colonography during the measurement year or the four years prior to the measurement year
  • Stool DNA (sDNA) with FIT test during the measurement year or the two years prior to the measurement year

If you would like to report this measure via Electronic Clinical Data Reporting system you will need to select: Colorectal Cancer Screening (COL-E).


Reminder: please make sure to document all of needed information in the patient medical records.


#HEDIS #Cancer #primarycare #physicians #NCQA


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