June 17, 2025
Participating providers in our Medicare Advantage networks can earn an additional incentive payment when submitting claims with certain Current Procedural Terminology (CPT®), CPT Category II and Healthcare Common Procedure Coding System codes.
Why it matters: The purpose of this incentive program is to encourage use of CPT II codes on MA claims. CPT II codes are supplemental tracking codes that can be used for performance measurement, allowing providers and insurers to track the delivery of quality care.
Related quality measures: This initiative is related to the following Healthcare Effectiveness Data and Information Set (HEDIS®) measures:
- Eye Exam for Patients with Diabetes (EED)
- Care for Older Adults (COA)
Where to find our list of codes and incentive amounts: Log on to Availity® Essentials to view the Medicare Advantage Coding Incentive List. It’s in our Payer Spaces section, under the Resources tab. This list outlines HEDIS measures and applicable CPT, CPT II and/or HCPCS codes that, when billed correctly on MA member claims for medically necessary care, will result in incentive payments to providers. The coding incentive list is subject to change. Be sure to view the current list in Availity for the most updated information.
Summary of recent changes: Originally published Nov. 1, 2024, the coding incentive list has been updated, effective June 1, 2025.
- Some codes related to eye care services were removed
- Some codes related to eye care services were added
- Clarification was added to the description to identify codes that must be performed by an eye care provider (optometrist or ophthalmologist) to be eligible for incentive.
CPT copyright 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
HEDIS is a registered trademark of the National Committee for Quality Assurance.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of New Mexico. BCBSNM makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
This material is for educational purposes only and is not intended to be a definitive source for coding claims. Health care providers are instructed to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials.