Date Issued: 5/22/2012
Category II CPT codes are not separately valued or reimbursable.
Category II Current Procedural Terminology (CPT®) codes do not have a relative value associated with them. They are used to report quality measures only. Use of Category II CPT codes is optional (not required for correct coding) and may not be used as a substitute for Category I CPT codes.
No payment is associated with Category II CPT codes. EmblemHealth does not reimburse for these codes. Payment is also not due from the member.
Purpose
Category II CPT codes are supplementary tracking codes used to measure the performance of certain services or test results that contribute to quality patient care. The use of these codes decreases the need for record abstraction and chart reviews.
Identification
Category II CPT codes are alphanumeric — consisting of four digits followed by the use of the alpha character 'F.' (Category I CPT codes are five-digit numeric codes.)
Category II CPT codes are listed in a separate section of AMA's Current Procedural Terminology (CPT) code book and are arranged according to a specific, easily-identifiable taxonomy that is based on the SOAP clinical documentation format.
SOAP stands for:
Subjective: Historical information about the problem as reported by the patient
Objective: Information about the problem obtained from the physical exam and test results
Assessment: An analysis by the physician or health professional to determine the problem
Planning: All decisions and actions made to address the problem
