Important Reminder: Diabetic Care Coordination

Date: 01/02/25

Ambetter from Arkansas Health & Wellness is committed to improving the health of the community by helping people with diabetes lead healthier lives. Because of your vital role in patient health, we are asking for your help in facilitating preventive care through annual diabetic eye exams and reporting of exam findings.

Routine retinal evaluation is recommended to reduce the risk of diabetes-related blindness. While exams do not require prior authorization, please be sure to adhere to Ambetter’s clinical policies regarding medical necessity.

Please reference plan specifics and applicable billing guidelines when selecting the most appropriate CPT® code for services rendered. Using these codes may help reduce the need for medical record reviews.

CPT:
65091, 65093, 65101, 65103, 65105, 65110, 65112, 65114, 67028, 67030, 67031, 67036, 67039-67043, 67101, 67105, 67107, 67108, 67110, 67113, 67121, 67141, 67145, 67208, 67210, 67218, 67220, 67221, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92134, 92201, 92202, 92227, 92228, 92230, 92235, 92240, 92250, 92260, 99203-99205, 99213-99215, 99242-99245

CPT II:
*2022F, 2024F, 2026F, 3072F

HCPCS:
S0620, S0621, S3000

Diagnosis Code (diabetes without complications):
E10.9, E11.9, E13.9*

Note: When submitting CPT II codes, you may be entitled to a $10 bonus payment per member per year. Providers must bill $10 in the claim filing to receive reimbursement.

For additional information or for training and support, contact Ambetter’s Quality Improvement HEDIS® team at QI_AR_HEDIS@centene.com.