Summary & Overview
HCPCS G9672: Diabetic Retinopathy Quality Actions Completed
HCPCS Level II code G9672 documents that all required quality actions for the diabetic retinopathy measures group have been completed for a patient. As a quality-reporting code, it is used to record fulfillment of measure-based care processes tied to diabetic retinal disease management, supporting performance tracking and payer reporting. Nationally, use of such quality codes affects quality programs, value-based contracting, and public reporting tied to chronic disease outcomes.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical and administrative purpose, expected sites of service, and typical service type. The publication also summarizes benchmarking and reporting implications, common payer coverage patterns where available, and the clinical context linking diabetic retinopathy care processes to quality measurement.
The content provides operational clarity for clinicians and billing teams on when G9672 is appropriate to report, how it fits into diabetic eye care quality workflows, and what stakeholders (payers and providers) use the code for in measure reporting and performance programs. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code G9672 indicates that all quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient. This reflects completion of the specified quality measures tied to diabetic retinopathy management.
Service type: Quality reporting/quality measure completion
Typical site of service: Outpatient ophthalmology or retina clinic, outpatient diabetes care setting, or other ambulatory care sites where diabetic eye care and quality reporting are performed.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a long-standing history of type 2 diabetes attends a scheduled ophthalmology visit for diabetic eye disease management. The patient has prior documentation of nonproliferative diabetic retinopathy and is due for a comprehensive diabetic retinopathy quality assessment. The clinical workflow includes verification of diabetes diagnosis, review of prior ophthalmic imaging and exams, performance of a dilated fundus examination, acquisition and review of retinal imaging (such as fundus photography or optical coherence tomography), documentation of glycemic control counseling and referral status, and confirmation that all measure-specific actions in the diabetic retinopathy measures group were completed. After the visit, the clinician documents each required quality action (screening, imaging, treatment plan or referral, patient education, and follow-up scheduling) and reports the HCPCS Level II code G9672 to indicate that all quality actions for the applicable diabetic retinopathy measures have been performed for this patient.
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 an E/M visit is distinct from the diabetic retinopathy quality services documented with G9672 |