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CPT Category II Codes
CPT Category II Codes allow you to share specific data quickly and efficiently with Aetna Better Health. A few key benefits to providers who submit CPT Category II Codes include:
- Decreased medical record requests from us for HEDIS data collection;
- Increased access to more accurate medical data which can help our efforts to support your care plan through more targeted case management services; and
- More frequent monitoring of key performance measures throughout the year, rather than once per year as measured by us for value based contracting arrangements.
The table below is a short list of HEDIS measures and their related CPT Category II Codes.
CPT Category II Codes are billed in the procedure code field. Because CPT Category II Codes are used for quality measurement purposes only, they are billed with a $0.00 charge amount.
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Quality Navigator Webinar Series
You're invited to attend our free Quality Navigator webinar series. The goal of the series is to:
- Educate on HEDIS measures
- Explore ways to cut down on the burden of medical record review and maximize administrative data capture
- Present NCQA HEDIS reporting codes that will effectively capture care
- Discuss HEDIS measures applicable to certain populations
- Open discussion to see how other providers are addressing HEDIS and barriers to care
- Strategies for improvement
- Connect you with a single point of contact at the health plan for HEDIS/Quality questions
Check your inbox for monthly invites and registration information.
If you are not currently receiving the invitations and would like to start receiving them, please send your name and email address via email to your PRL listed below.
Questions?
For HEDIS related questions contact our HEDIS Help Line at 855-750-2389.
Schedule
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November 2017
HEDIS measures affecting 0-11 year old members including EPSDT
December 2017
HEDIS measures affecting 12-21 year old members, with a focus on administrative data capture vs medical record review
January 2018
Maternity Care / ONAF submission
February 2018
HEDIS measures affecting 21 and older males
March 2018
HEDIS measuring affecting 21 and older females.
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April 2018
HEDIS measures focusing on members with serious and mental illness and chronic conditions.
May 2018
Why attend these Webinars and what exactly is a "point of contact"? / HEDIS measures affecting 0-11 year olds including EPSDT.
June 2018
HEDIS measures affecting 12-21 year old members. A focus on administrative data
capture vs medical record review.
July 2018
Maternity care / ONAF submission
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 Quality Improvement Program
Every year, Aetna Better Health of Ohio reviews the Consumer Assessment of Health Plans Survey (CAHPS®) and Healthcare Effectiveness Data and Information Set (HEDIS®) results to create quality improvement initiatives. These initiatives are designed to improve our health plan's services to members. You can find out more about our quality improvement program by going to our website at www.aetnabetterhealth.com/ohio.
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 Care Management Program
All Aetna Better Health of Ohio members have a care manager. This person works with the member and care providers to make sure they get the care and services they need. You can contact your members' care managers by calling our Care Management line at 1 855 364 0974, Option 5, 24 hours a day, 7 days a week.
Aetna Better Health has five levels of care management. Higher levels of care management include more contacts from the Care Manager to the member and more help managing their diseases. You, your members, or your members' caregivers can ask for the member to be in a higher level of care management by calling the Care Management line.
Additionally, members with chronic conditions are automatically enrolled in our Chronic Condition Management Program. These programs include additional help with specific conditions, condition specific assessments, educational materials, and strategic goal planning to help members self-manage their conditions. If your members have chronic conditions, you can work with the members' care managers to develop goals and self-management plans specific to the conditions on which you are working with your members.
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List of Covered Drugs 
Our List of Covered Drugs (or "Drug List") provides the prescription drugs that are covered by Aetna Better Health of Ohio.
The Drug List also indicates if there are rules or restrictions on any drugs, such as a limit on the quantity. Each year, we send a copy of the Drug List, but some changes may occur during the year. To get the most current information about which drugs are covered, you can visit the plan's website at www.aetnabetterhealth.com/ohio. You will also find information about:
- Covered drugs
- Copayment information, including tiers
- Drugs that require prior authorization
- Limits on refills, doses, or prescriptions
- Use of generic substitution, therapeutic interchange, or step-therapy protocols
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Member Rights and Responsibilities
As a practitioner who ensures high quality care for Aetna Better Health of Ohio members, you should be aware of the members' rights and responsibilities. Some of the rights we provide to our members are as follows:
- A right to receive information about Aetna, our services, our practitioners and providers, and member rights and responsibilities
- A right to be treated with respect and recognition of the member's dignity and right to privacy
- A right to participate with practitioners in making decisions about their health care
- A right to a candid discussion of appropriate or medically necessary treatment options, regardless of cost or benefit coverage
- A right to voice complaints or appeals about Aetna or the care we provide
- A right to make recommendations regarding Aetna's member rights and responsibilities policy
In addition, our members have the following responsibilities:
- A responsibility to supply information (to the extent possible) that Aetna and our practitioners and providers need in order to provide care
- A responsibility to follow plans and instructions for care that they have agreed to with their practitioners
- A responsibility to understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible
For a complete list of member rights and responsibilities, visit our website at www.aetnabetterhealth.com/ohio to see our Member Handbook.
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Fee Table
Providers must bill according to CMS and Medicaid guidelines. It is also the provider's responsibility to be familiar with the latest billing practices. Aetna is not responsible for instructing providers how to correctly bill for services.
Also, providers should frequently check the state's Fee Schedule & Rates website as updates are always occurring to the fee schedules for Medicaid.
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Disclaimers
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Aetna Better Health® of Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees.
Aetna Better Health® of Ohio complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
English: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-800-385-4104 (TTY: 711).
Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-385-4104 (TTY: 711).
Somali: FEEJIGNAAN: Haddii af-Soomaali aad ku hadasho, adeegyada gargaarka luqadda, oo bilaash ah, ayaad heli kartaa. Wac 1-800-385-4104 (Kuwa Maqalka ku Adag 711).
Nepali:
ध्यान
दिनुहोस्
:
तपार्इंले
नेपाली
बोल्नुहुन्छ
भने
तपार्इंको
निम्ति
भाषा
सहायता
सेवाहरू
निःशुल्क
रूपमा
उपलब्ध
छ
।
फोन
गर्नुहोस्
1-800-385-4104 (
टिटिवाइ
: 711)
।
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