At Blue Cross and Blue Shield of North Carolina (Blue Cross NC), we appreciate all that our providers do to support the health and well-being of our members. Our goal is to enhance care coordination, address social determinants of health, and support high-need populations through targeted care management and aligned provider engagement.

As part of our ongoing commitment to helping deliver high-quality, value-based care to North Carolinians, Blue Cross NC will continue implementing our provider incentive program—previously known as “Dual Eligible Special Needs Plan (D-SNP) Quali-D" and now renamed the D-SNP Quality Incentive Program (QIP)—focused on closing care gaps for our D-SNP members in 2026. D-SNP members are individuals who qualify for both Medicare and Medicaid.

To maximize impact for our D-SNP members, this program will prioritize providers with the greatest opportunity to influence outcomes within the D-SNP population.

This program includes two key components designed to maximize quality of care for our 2026 D-SNP population:

I. Provider Care Gap Incentive - $50 per closed gap for the following Medicare Advantage (MA) Star measures

• BCS - Breast Cancer Screening
• CBP - Controlling High Blood Pressure
• COA - Care for Older Adults - Functional Status Assessment
• COL - Colorectal Cancer Screening
• COA - Care for Older Adults - Medication Review
• EED - Eye Exam for Patients with Diabetes
• FMC - F/U After ED Visit for People with Multiple High-Risk Chronic Conditions
• GSD - Glycemic Status Assessment for Patients with Diabetes HbA1c Control <=9%
• KED - Kidney Health Evaluation for Patients with Diabetes
• Medication Adherence for Cholesterol (Statins)
• Medication Adherence for Diabetes Medications
• Medication Adherence for Hypertension (RAS Antagonists)
• SPC - Total Statin Therapy for Patients with Cardiovascular Disease
• TRC - Medication Reconciliation

Including the corresponding CPT service codes is crucial for automatic gap closure.

Below summarizes additional tips on CPT category II codes to help support our collective efforts in quality reporting and member care. These informational codes support timely care gap closure and help ensure the health plan maintains accurate and up-to-date member profiles for quality reporting purposes. However, they are not a substitute for the official measure specifications documents or reference guides. Always reference the latest HEDIS Technical Specifications and the Provider Reference Guides to ensure accurate and up-to-date documentation.

• CBP, Controlling High Blood Pressure: The percentage of members 18-85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure was controlled during the measurement year.
  • Blood pressure goal is 139/89 or lower.
  • Include the appropriate CPT II Code: 3074F, 3075F, 3077F, 3078F, 3079F, 3080F, according to the most recent blood pressure value.
• EED, Eye Exam for Patients with Diabetes: Members 18-75 years of age with diabetes (Types 1 and 2) who had a retinal eye exam.
  • If you have or reviewed a report from the member's ophthalmologist or optometrist, submit a claim with appropriate CPT II code: 2022F, 2023F, 2024F, 2025F, 2026F, 2033F.
• GSD, Glycemic Status Assessment for Patients with Diabetes / Glycemic Status <= 9.0%: The percentage of members 18-75 years of age with diabetes (Types 1 and 2) whose most recent glycemic status (hemoglobin A1c [HbA1c]) or glucose management indicator (GMI) was controlled.
  • Include CPT II codes according to the HbA1c value: 3044F, 3051F, 3052F.
• COA, Care for Older Adults-Medication: The percentage of adults 66 years and older who had a medication review during the measurement year.
  • Include CPT Category II code 1160F if you reviewed current medications.

II. Provider Annual Planned Visit (APV) Incentive - $75 per closed gap for APVs

Codes Associated with APVs:

• 99391 through 99397 - Annual Comprehensive Preventive Visit
• 99381 through 99387 - Initial Comprehensive Visit
• G0402 - Welcome to Medicare Exam - Physical examination; face-to-face visit, services limited to new beneficiaries during the first 12 months of Medicare enrollment.
  • The Welcome to Medicare Exam can only be performed ONCE per lifetime. This is different from the Annual Exam codes.
• G0438 - Initial Annual Exam - Visit - Includes a personalized prevention plan of service (PPS), initial visit.
  • The Initial Annual Exam can only be performed ONCE per lifetime. This code is different from the Welcome to Medicare exam.
• G0439 - Annual Exam - Annual Wellness Visit, includes a personalized prevention plan of service (PPS), subsequent visit.

The HEDIS Pocket Guide can assist you with code requirements for the various HEDIS measures as well as lookback periods, according to the latest HEDIS Technical Specifications, and can be accessed at MY 2026 Blue Cross NC Provider Reference Guide (PDF).

Blue Cross NC will issue incentive payments in the summer of 2027 to participating providers who close the above-listed care gaps for dates of service between January 1, 2026, and December 31, 2026.

If you have questions or need additional information, please email the Quality Management team at Blue Cross NC.

Thank you for being a valued partner of Blue Cross NC.