Sept. 18, 2025
We created a new resource for you on coding and documentation for Healthcare Effectiveness and Data Information Set (HEDIS®) measures. Accurate and complete coding is an important step in capturing our members’ health status.
To access the resource: Sign in to Availity Essentials and visit our Payer Spaces. You can download the resource, titled Quality Care 2025, from the Resources section under Quality Improvement.
The resource includes Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System and ICD-10-CM codes in quality areas including:
- Breast and colorectal cancer screening
- Controlling high blood pressure
- Immunizations
- Diabetes care, including glycemic status assessment, retinopathy screening, statin therapy and kidney health evaluations
- Prenatal and postpartum care
- Well-child visits
Why we track care gaps: Like many insurers, we use HEDIS measures to identify care our members may need, such as preventive screenings and chronic care management. We gather this information to help you close our members’ care gaps.
The resource is for informational/educational purposes only, is not intended to be medical advice or a definitive source for coding claims and is not a substitute for the independent medical judgment of a physician or other health care provider. This information isn’t intended to replace or supersede any requirements set forth in your contract with Blue Cross and Blue Shield of Montana and should not be relied on in determining how a specific provider will be reimbursed. In the event of a conflict between this information and your contract, your contract will control. Health care providers are encouraged to exercise their own independent medical judgment based upon their evaluation of their patients’ conditions and all available information, and to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their member contract or member guide for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
CPT copyright 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
HEDIS is a registered trademark of the National Committee for Quality Assurance.