Medicare AdvantageReimbursementMedium impact
Code Effectively to Earn Additional Incentive Payments on Medicare Advantage Claims
BCBS Texas·TX · Ophthalmology, Optometry, Family Medicine +2 more·Reimbursement
Effective date
Jun 1, 2025
We identified it
Jan 12, 2026
Summary
Blue Cross Blue Shield of Texas updated their Medicare Advantage coding incentive program effective June 1, 2025. Providers can earn additional incentive payments by using specific CPT, CPT II, and HCPCS codes on Medicare Advantage claims, with recent updates removing and adding eye care service codes and clarifying that certain codes must be performed by eye care providers to qualify for incentives.
Action Required
Immediately: Billing team must log into Availity Essentials to access the updated Medicare Advantage Coding Incentive List under Payer Spaces > Resources tab. Review the current list of qualifying CPT, CPT II, and HCPCS codes for HEDIS measures (Eye Exam for Patients with Diabetes and Care for Older Adults) to maximize incentive payments on Medicare Advantage claims. Ensure eye care codes are only billed by optometrists or ophthalmologists to qualify for incentives.