CPT 1119F: Initial Evaluation for Program Measure

CPT code 1119F is a supplemental tracking code indicating that an initial evaluation was completed for a condition relevant to a specified program measure. As a documentation-oriented CPT code rather than a procedure or treatment code, 1119F serves administrative and quality-reporting purposes by flagging that an initial clinical assessment has occurred for patients within the measure population. Nationally, such tracking codes support performance measurement, quality reporting and care coordination by creating a standardized way to record that an initial evaluation took place.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise explanation of the code's clinical and reporting role, typical service setting, and what to expect in payer coverage patterns. The publication summarizes how 1119F is used for measure documentation, outlines common contexts where the code appears in claims, and highlights related administrative considerations for national quality reporting. Data limitations and missing specific payor-level modifiers, taxonomies, and diagnosis mappings are noted as "Data not available in the input."

Billing Code Overview

CPT code 1119F documents that an initial evaluation for a condition relevant to the program measure being reported was performed. This code functions as a supplemental tracking code used to indicate that an initial assessment applicable to the measure population occurred.

Service type: Initial evaluation and assessment for a condition relevant to the reporting measure
Typical site of service: Outpatient clinic or ambulatory care setting where initial evaluations are performed

Data not available in the input.

Clinical Context

A primary care clinician or preventive medicine specialist documents an initial evaluation for a condition relevant to a longitudinal program measure that the practice tracks (for example, hypertension control, smoking cessation counseling, or diabetes preventive care). The patient is seen for an initial assessment specific to the measure: history, focused exam, review of prior records, baseline metrics (such as blood pressure, HbA1c, or smoking status), and creation of a care plan or referral for disease-specific services. Documentation supports that this is the initial evaluation for the condition relevant to the program measure and is used as a supplemental tracking code to indicate the evaluation was performed and recorded in the medical record. Typical workflow: patient presents for new or established primary care visit; clinician performs focused assessment tied to the quality measure, documents findings and plan in the chart, and reports the supplemental tracking code 1119F in the patient’s encounter or quality reporting submission. Typical site of service is an outpatient clinic, primary care office, or preventive medicine setting. Typical patient scenario: a 52-year-old patient with elevated screening blood pressure is evaluated for a new diagnosis of hypertension with baseline home and clinic readings recorded, medication counseling initiated, and a follow-up plan documented to support hypertension quality measure reporting.

Coding Specifications

Modifier	Description	When to Use
`25`

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians who commonly perform initial evaluations tied to quality measures
`207R00000X`	Internal Medicine	Internists providing chronic disease evaluations for measure reporting
`207T00000X`	Preventive Medicine	Specialists focused on screening and preventive measure assessments
`103K00000X`	Nurse Practitioner	Advanced practice clinicians documenting initial evaluations for quality measures
`367A00000X`	Physician Assistant	PAs who often perform and document evaluations used for measure tracking

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I10`	Essential (primary) hypertension	Common diagnosis when an initial evaluation documents baseline blood pressures and care plan for hypertension quality measures
`E11.9`	Type 2 diabetes mellitus without complications	Often evaluated initially to establish baseline control and plan for diabetes quality measures
`F17.210`	Nicotine dependence, cigarettes, uncomplicated	Used when smoking status and cessation counseling are part of an initial preventive measure evaluation
`E78.5`	Hyperlipidemia, unspecified	Included when initial lipid assessment and management are documented for cardiovascular prevention measures
`Z00.00`	Encounter for general adult medical examination without abnormal findings	May be used when an initial preventive evaluation for program measures is performed during a wellness visit

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99201`	Office or other outpatient visit for the evaluation and management of a new patient, problem-focused	May be the billed E/M code when an initial evaluation for a quality measure is performed in-office
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Commonly billed for follow-up visits that accompany the initial evaluation documentation for measures
`36415`	Collection of venous blood by venipuncture	Often performed to obtain baseline laboratory values during the initial evaluation for chronic disease measures
`83036`	Hemoglobin; glycosylated (A1c)	Frequently ordered during initial diabetes evaluations relevant to quality measures
`93784`	Ambulatory blood pressure monitoring, utilizing a device worn by the patient, with recording and interpretation	May be used when ambulatory blood pressure is obtained as part of an initial hypertension evaluation tracked by measures

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Summary & Overview