May 13, 2025
About 38 million Americans have diabetes, according to the Centers for Disease Control and Prevention. Because symptoms can develop slowly, one in five of them don’t know they have it. You may play an important role in supporting our members through regular screenings, tests and office visits.
We track Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the National Committee for Quality Assurance related to diabetes care, including:
Glycemic Status Assessment for Patients with Diabetes captures the percentage of our members ages 18 to 75 with diabetes (type 1 and type 2) whose most recent glycemic status (hemoglobin A1C) or glucose management indicator was at the following levels during the measurement year:
- Glycemic status less than 8.0%
- Glycemic status greater than 9.0%
Blood Pressure Control for Patients with Diabetes captures members ages 18 to 75 with diabetes (type 1 and type 2) whose blood pressure was controlled (<140/90 mm Hg).
Eye Exam for Patients with Diabetes tracks members ages 18 to 75 with diabetes (type 1 and type 2) who have a retinal eye exam by an eye care professional to screen or monitor for diabetic retinal disease.
Kidney Health Evaluation for Patients with Diabetes tracks members ages 18 to 85 with diabetes (type 1 and type 2) who received a kidney health evaluation during the measurement year. An evaluation includes a blood test for kidney function (estimated glomerular filtration rate) and a urine test for kidney damage (urine albumin-creatinine ratio).
Statin Therapy for Patients with Diabetes tracks members ages 40 to 75 who have diabetes and do not have clinical atherosclerotic cardiovascular disease, and who received and adhered to statin therapy.
Tips to close gaps in care
- Identify care gaps and schedule lab tests before office visits to review results and adjust treatment plans if needed.
- Document the date glycemic status assessments are performed and the results. If documenting glucose management indicators, include the date range and value. Use Current Procedural Terminology (CPT®) II codes to identify the most recent HbA1C test during the measurement year. Repeat abnormal lab tests later in the year to document improvement.
- Monitor blood pressure status at each visit and adjust medications as needed for control.
- Document medication adherence to angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers when applicable.
- Encourage members with diabetes to have annual retinal or dilated eye exams by an eye care professional.
- For our members on statin therapy, discuss the proper dose, frequency and importance of staying on the medication.
- Communicate with members and other treating providers to ensure all tests are completed and results are documented in the medical record.
Resources
- Information on CPT Category II codes is available in Availity® Essentials in Payer Spaces in the Resources section. It includes information on coding for Glycemic Status Assessment for Patients with Diabetes and Blood Pressure Control for Patients with Diabetes.
- We have information to support discussions about diabetes with our members.
- See our preventive care and clinical practice guidelines for more information on diabetes.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Illinois. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
CPT copyright 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
HEDIS is a registered trademark of NCQA.