Summary & Overview
CPT 0526F: Clinical Quality Measure
CPT code 0526F is listed as a clinical quality measure within the CPT code set. While the available description states "No Summary found for this code," the code is part of the performance measurement framework used in clinical reporting and payer quality programs. It matters nationally because CPT performance measures influence quality reporting, value-based payment adjustments, and provider performance benchmarking across public and private payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of what the code represents, its role in quality measurement, and the national context for how such codes are used by major payers. The publication also identifies gaps in the provided metadata and directs readers to areas where additional clinical detail, service location, and coding associations are typically needed for operational use.
This executive summary provides a concise orientation to CPT code 0526F, the payers commonly involved in quality-measure reporting, and the types of information that stakeholders consult when mapping codes to clinical workflows, claims processing, and reporting programs.
Billing Code Overview
CPT code 0526F represents a clinical quality measure related to medical care. The published description for this code is: No Summary found for this code.
Service type: Data not available in the input.
Typical site of service: Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult undergoing routine preventive care where a clinician documents and reports a specific performance measure related to immunizations or preventive counseling. The workflow begins with patient intake and review of medical history, including vaccination status and risk factors. The clinician confirms eligibility, provides counseling or administration of a preventive service (for example, influenza vaccination or smoking cessation counseling), documents the service and measure elements in the medical record, and selects the appropriate quality-reporting CPT performance code for submission to payors and quality programs. Documentation includes date and type of service, patient consent, any contraindications, and measure-specific fields required for reporting to payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service | Use when a distinct E/M visit is provided on the same day as the preventive service or quality-measure activity. |
| 59 | Distinct procedural service | Use to indicate a different session, procedure or site when two services would otherwise be bundled.
| | CLIA waived test | Use when a waived point-of-care test was performed as part of the service (if applicable to measure reporting).