FAQ Directory: HEDIS

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12.15.2015 PQRS Codes for HEDIS Reporting Physician Quality Reporting System (PQRS) includes CPT Category II codes and HCPCS codes, some of which are not included in the HEDIS value sets. May organizations map these codes for use in HEDIS reporting?

No. Because CPT Category II codes and HCPCS are standard codes they are not eligible for mapping (the value sets include all standard codes that have been identified as appropriate for use in HEDIS reporting). The Category II and HCPCS codes included in PQRS measures were created specifically for use in PQRS reporting and are not appropriate for use in reporting HEDIS measures. If a service or procedure was rendered by a provider, the expectation is that the provider will submit a claim to the health plan for the service or procedure; the codes expected to be on the claim are included in the HEDIS value sets and identify the member for the HEDIS measure.

HEDIS 2016