Table 1.

Codes Used to Identify Diabetes Care Processes and Alzheimer’s Disease or Related Disorder (ADRD)

Care Process	Description
HbA1c tests	CPT codes on carrier or outpatient facility claims: 83036 or 83037
LDL cholesterol tests	CPT codes on carrier or outpatient facility claims: 83721, 80061, 83715, 83716, 83700, 83701, or 83704, or a combination of 82465, 83718, and 84478 on the same claim
Eye exams	CPT codes on carrier, outpatient, or inpatient claims: 67101, 67105, 67107, 67108, 67110, 67112, 67141, 67145, 67208, 67210, 67218, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92225, 92226, 92230, 92235, 92240, 92250, 92260 CPT codes on carrier claims associated with a provider specialty code of 18 (ophthalmology) or 41 (optometry): 99201–99215, 99241–99245 ICD-9-CM procedure codes on acute inpatient claims: 14.21, 14.22, 14.23, 14.24, 14.25, 14.26, 14.27, 14.29, 14.31, 14.32, 14.33, 14.34, 14.35, 14.39, 14.41, 14.49, 14.51, 14.52, 14.53, 14.54, 14.55, 14.59, 14.9, 95.02, 95.03, 95.04, 95.11, 95.12, 95.16
Diagnosis of Alzheimer’s Disease or Related Disorder (ADRD)	ICD-9-CM diagnosis code in any position on at least 1 inpatient, skilled nursing facility, home health, hospital outpatient, or carrier claim: 331.0, 331.1, 331.11, 331.19, 331.2, 331.7, 290.0,290.1, 290.10, 290.11, 290.12, 290.13, 290.20, 290.21,290.3, 290.40, 290.41, 290.42, 290.43, 294.0, 294.1,294.10, 294.11, 294.8, 797

HbA1c = Hemoglobin A1c; LDL = Low-density lipoprotein; CPT = Current Procedural Technology; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification