May 14, 2026
According to the Centers for Disease Control and Prevention, approximately 38 million Americans have diabetes. Because symptoms can develop slowly, one in five of them don’t know they have it. You 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 hemoglobin A1c was at the following levels during the measurement year:
- Less than 8.0%
- Greater than 9.0%
Eye Exam for Patients with Diabetes tracks members ages 18 to 75 with diabetes (type 1 and type 2) who had diabetic retinopathy screening.
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 in 2026. An evaluation includes glomerular filtration rate and 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 were adherent to statin therapy.
Tips to close gaps in care:
- Identify care gaps and scheduled lab tests before office visits to review results and adjust treatment plans, if needed.
- Document the exact date hemoglobin A1c assessments were performed and the results. Use Current Procedural Terminology (CPT®) Category II codes to codify test results and facilitate gap closure. Repeat abnormal lab tests later in the year to document improvement.
- Monitor and document blood pressure status at each visit and adjust medications as needed for control.
- Document medication adherence and make necessary adjustments to medications.
- 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. Encourage 90-day fills where applicable.
- Communicate with members and other treating providers to ensure all tests are completed, and results and test dates are documented in the medical record.
Resources
- Refer to our Quality Care 2026 booklet on Healthcare Effectiveness Data and Information Set (HEDIS®) measures for information on documentation, coding and exclusions for these measures. You can access it in Availity® Essentials within our Payer Spaces in the Resources section.
- 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 New Mexico. BCBSNM makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
CPT copyright 2025 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
HEDIS is a registered trademark of NCQA.