CMS Approves Use of Healthcare Common Procedure Coding System (HCPCS) Billing with CPT Category II Modifier 8P for CMS ID 117: Diabetes: Eye Exam for Performance Year 2020

Effective January 1, 2020, the Centers for Medicare & Medicaid Services and the American Medical Association have approved the use of the CPT Category II 8P modifier with HCPCS codes included in Quality ID #117’s  measure specifications to report Performance Not Met.

BACKGROUND: In their October 2019 coding update, CMS revised 3 CPT Category II codes that the AMA released on July 8, 2019, for implementation on October 1, 2019. These revisions had a substantive impact on the numerator definitions for Quality Measure 117: Diabetes: Eye Exam. To avoid impact to PY 2020, CMS replaced the affected CPT Category II codes with 3 new HCPCS codes. To report Performance Not Met for this measure, reporters should append CPT Category II modifier 8P to the HCPCS codes found in the numerator. The new HCPCS codes and descriptions for this measure are found below. The QPP 2020 measure specifications contain the correct codes and instructions for reporting this measure. The 2020 measure specifications may be found at https://qpp.cms.gov/about/resource-library.

Numerator Options:
Performance Met:	Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed (G2102)
OR Performance Met:	Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed (G2103)
OR Performance Met:	Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed (G2104)
OR Performance Not Met:	Dilated eye exam was not performed, reason not otherwise specified (G2102 with 8P or G2103 with 8P or G2104 with 8P)

This change applies only to QI 117: Diabetes Eye Exam. Questions may be directed to the Quality Payment Program Service Center at QPP@cms.hhs.gov.