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CPTII Codes and HCPCS Billing for Medicare

Important Information on CPT II and HCPCS Codes

We’re asking our providers to make sure to use accurate CPT Category II codes and HCPCS codes to improve efficiencies in closing patient care gaps and in data collection for performance measurement. When you verify that you performed quality procedures and closed care gaps, you’re confirming that you’re giving the best of quality care to our members.
Wellcare has made a change to CPTII code payment to assist in the pursuit of Quality. Starting January 1, 2020, Wellcare will add CPTII and HCPCS codes to the fee schedule at a price of $0.01. This will allow billing of these important codes without a denial of “non-payable code”.

How does this help you, our Providers?

  • Fewer dropped codes by Billing Companies due to non-payable codes
  • Better reporting of open and closed care needs for your assigned members
  • Increase in Payment for Quality (P4Q) due to submission of additional codes
  • Collection of HEDIS® measure data year round, resulting in fewer chart requests during chart collection season

What measures do these codes apply to?

  • Controlling Blood Pressure
    • Blood pressure results
  • Comprehensive Diabetes Care
    • Hba1c levels
    • Nephropathy – urine protein tests
      or treatment
    • Diabetic Retinal Eye Exams, DRE
  • Care of Older Adults
    • Pain Assessment
    • Medication List and Review
    • Functional Status Assessment
  • Medication Reconciliation Post Discharge
    • Medication List and Review after hospital discharge

Please use the following document to alert your Billers and Billing Companies.

Attention Billers:
Starting January 1, 2020 Wellcare Health Plans will be paying $0.01 for CPTII and HCPCS codes associated with Quality Measures.

Download the flyer This PDF document will open in a new window. to view the list of codes that must be billed on all claims and encounters when applicable.


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