Follow-up information regarding use of CPT Category II Codes

As a reminder, the Division of Medicaid (DOM) will require providers to include accurate CPT® Category II codes on physician, physician assistant, and nurse practitioner claims, effective October 1, 2021.  The chart below reflects potential CPT Category I codes that could be used in combination with CPT Category II codes which are billed in the procedure code field, just as CPT Category I codes. However, Category II Codes are not reimbursable.  The CPT II codes are to be billed with a $0 charge amount and are not a substitute for CPT Category I codes.

CPT Category II Codes are supplemental tracking codes used for performance measurement and data collection related to quality and performance measurement, including Healthcare Effectiveness Data and Information Set (HEDIS®).  Use of CPT Category II Codes will allow providers to report services and/or values based on nationally recognized, evidence-based performance guidelines for improving quality of patient care, which may decrease the need for chart abstractions.  CPT Category II codes are more specific than CPT I codes and describe components that are typically included in an evaluation and management (E&M) service or test results that are part of the laboratory test/procedure. Use of CPT Category II codes for services performed during office, lab, or facility visits will provide more accurate medical data and decrease requests for members’ records for review.  The more specific codes identify and close gaps in care more accurately and quickly – this drives HEDIS measures and quality improvement initiatives.  Please note that Wellness – Child and Adolescent measures should be reported beginning at the age 3 well child visit.

The notification for this requirement was sent in July 2021; however, DOM is aware that some electronic health record (EHR) systems may require modifications that will not be ready to accommodate use of CPT Category II codes by October 1, 2021.  DOM will continue to accept claims without the category II codes through October 31, 2021.  If you have any questions, please contact the Office of Medical Services at 601-359-6150 or at OMS@medicaid.ms.gov.

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