Skip to Main Content

Johns Hopkins Health Plans

KED- Kidney Health Evaluation for Patients with Diabetes

Product Lines:
Advantage MD, EHP, Priority Partners, and USFHP.

Measurement Period: January 1 - December 31

Description:
The percentage of persons 18–85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR), during the measurement period.

Stratifications: 
Age as of the start of the measurement period.

  • 18–64 years.
  • 65–75 years.
  • 76–85 years.

Report stratification by race and ethnicity.

Measure Reporting:
CMS Start Rating Measure- New for MY 2026. 
HealthChoice Performance Measure reporting for Priority Partners. 

Improvement Notation:
Increased score indicates improvement.

Data Collection:

  • Administrative.
  • Supplemental.

Initial Population:

  • Measure Item Count: Person.
  • Age:18–85 years of age as of the last day of the measurement period.
  • Benefits: Medical.
  • Continuous Enrollment: The measurement period.
  • Allowable Gap: No more than one gap of ≤45 days during the measurement period. No gaps on the last day of the measurement period.

Denominator:
Persons with a diagnosis of diabetes. 

  • Claim/encounter data. At least two diagnoses of diabetes on different dates of service during the measurement period or the year prior to the measurement period. 
  • Pharmacy data. At least one diagnosis of diabetes and at least one diabetes medication dispensing event of insulin or a hypoglycemic/antihyperglycemic medication during the measurement period or the year prior to the measurement period. 

Numerator:
Kidney health evaluation.
Persons who received both an eGFR and a uACR during the measurement period on the same or different dates of service:

  • At least one eGFR (Estimated Glomerular Filtration Rate Lab Test Value Set).
  • At least one uACR identified by either of the following:
    • Both a quantitative urine albumin test (Quantitative Urine Albumin Lab Test Value Set) and a urine creatinine test (Urine Creatinine Lab Test Value Set) with service dates four days or less apart. 
      • For example, if the service date for the quantitative urine albumin test was December 1 of the measurement period, then the urine creatinine test must have a service date on or between November 27 and December 5 of the measurement period.
    • A uACR (Urine Albumin Creatinine Ratio Lab Test Value Set).

Best Practice and Measure Tips

  • Both an estimated Glomerular Filtration Rate (eGFR) and a urine albumin-to-creatinine ratio (uACR) must be completed during the measurement year. These tests may be performed on the same or different dates of service.
  • Members diagnosed with diabetes should be routinely referred for both assessments. To accurately calculate the uACR, a quantitative urine albumin test and a urine creatinine test must be performed within four or fewer calendar days of each other.
  • Requirement to Close Measurement Gap: Urine Albumin and Creatinine Testing
    • To satisfy compliance and fully close the measure gap, both of the following laboratory tests must be ordered, performed, and properly billed:
      • Quantitative urine albumin test – CPT code 82043
      • Urine creatinine test – CPT code 82570
        • These two CPT codes must be submitted together, as they represent the only acceptable combination for fulfilling the measure requirement.
    • Documentation and Testing Methods That Do Not Qualify:
      • Point-of-Care (POC) urine albumin tests: These are considered semi-quantitative and do not meet compliance criteria.
      • Urine protein-to-creatinine ratio (uPCR) tests: These are also semi-quantitative and therefore unacceptable.
      • CPT code 82044: Refers to semi-quantitative measurement of urine albumin (e.g., via reagent strip assay); this does not fulfill the requirement.
      • CPT code 84156: Pertains to total urine protein (UP); this test is not considered compliant for the measure.
  • Follow up with patients to discuss and educate on lab results.
  • Educate on how diabetes can affect the kidneys and offer tips to your patients on preventing damage to their kidneys.
  • Controlling their blood pressure, blood sugars, cholesterol, and lipid levels.
  • Take medications as prescribed that can protect kidney function (ACE inhibitors or ARBs).
  • Offer education on medications that could be harmful to the kidneys (NSAIDs such as naproxen or ibuprofen).
  • Limit protein intake and salt in diet.
  • Coordinate care with specialists such as an endocrinologist or nephrologist as needed.

Measure Exclusions

Denominator Exclusions:

  • Persons with a diagnosis of ESRD or who had dialysis any time during the person’s history on or prior to the last day of the measurement period.
  • Persons receiving Palliative Care or had an encounter for Palliative Care any time during the intake period through the last day of the measurement period.
  • Persons in hospice or using hospice services any time during the measurement period.
  • Persons who died any time during the measurement period.
  • Persons 66–80 years of age by the last day of the measurement period, with both frailty and advanced illness.
  • Persons 81 years of age and older as of the last day of the measurement period, with frailty.
  • Medicare enrollees, 66 years of age and older by the last day of the measurement period, in an institutional SNP (I-SNP) or living long-term in an institution (LTI).
  • Diagnosis code on a laboratory claim (POS 81) for:
    • Diabetes 
    • ESRD
    • Frailty
    • Advance illness
    • Palliative care

Exclusion Codes

Dialysis Procedure

  • CPT: 90935, 90937, 90945, 90947, 90997, 90999, 99512
  • HCPCS: G0257, S9339
  • ICD-10-PCS: 3E1M39Z, 5A1D00Z, 5A1D60Z, 5A1D70Z, 5A1D80Z, 5A1D90Z

ESRD Diagnosis

  • ICD-10-CM: N18.5, N18.6
  • SNOMED CT US Edition: 46177005, 236434000, 236435004, 236436003, 433146000, 698810000, 704667004, 707324008, 712487000, 714152005, 714153000, 1332467008, 711000119100, 90761000119106, 90771000119100, 90791000119104, 96711000119105, 111411000119103, 120261000119101, 127991000119101, 128001000119105, 129161000119100, 140101000119109, 153851000119106, 153891000119101, 285011000119108, 285841000119104, 286371000119107, 368461000119103, 368471000119109, 434431000124103

Measure Codes

To ensure gap closure, verify the practitioner orders and lab facilities include all three CPT codes, eGFR and both urine test, quantitative urine albumin lab test and urine creatinine lab test, in the claim.

Note: Measure can only be closed through claims or EMR supplemental data feed.

Estimated Glomerular Filtration Rate Lab Test

  • CPT: 80047, 80048, 80050, 80053, 80069, 82565
  • LOINC: 102097-3, 50044-7, 50210-4, 50384-7, 62238-1, 69405-9, 70969-1, 77147-7, 94677-2, 98979-8, 98980-6

Quantitative Urine Albumin Lab Test

  • CPT: 82043
  • LOINC: 100158-5, 14957-5, 1754-1, 21059-1, 30003-8, 43605-5, 53530-2, 53531-0, 57369-1, 89999-7

Urine Albumin Creatinine Ratio (uACR) Lab Test

  • LOINC: 13705-9, 14958-3, 14959-1, 30000-4, 44292-1, 59159-4, 76401-9, 77253-3, 77254-1, 89998-9, 9318-7

Urine Creatinine Lab Test

  • CPT: 82570
  • LOINC: 20624-3, 2161-8, 35674-1, 39982-4, 57344-4, 57346-9, 58951-5

Measure Medications

Diabetes Medications List 
Alpha-glucosidase inhibitors

  • Acarbose
  • Miglitol

Amylin analogs

  • Pramlintide

Antidiabetic combinations

  • Alogliptin-metformin 
  • Alogliptin-pioglitazone
  • Canagliflozin-metformin
  • Dapagliflozin-metformin
  • Dapagliflozin-saxagliptin
  • Empagliflozin-linagliptin
  • Empagliflozin-metformin
  • Empagliflozin-linagliptin-metformin
  • Ertugliflozin-metformin
  • Ertugliflozin-sitagliptin
  • Glimepiride-pioglitazone
  • Glipizide-metformin
  • Glyburide-metformin
  • Linagliptin-metformin 
  • Metformin-pioglitazone
  • Metformin-rosiglitazone
  • Metformin-saxagliptin
  • Metformin-sitagliptin

Insulin

  • Insulin aspart 
  • Insulin aspart-insulin aspart protamine
  • Insulin degludec 
  • Insulin degludec-liraglutide
  • Insulin detemir
  • Insulin glargine
  • Insulin glargine-lixisenatide 
  • Insulin glulisine 
  • Insulin isophane human
  • Insulin isophane-insulin regular
  • Insulin lispro
  • Insulin lispro-insulin lispro protamine 
  • Insulin regular human
  • Insulin human inhaled

Meglitinides

  • Nateglinide
  • Repaglinide

Biguanides

  • Metformin

Glucagon-like peptide-1 (GLP1) agonists

  • Albiglutide
  • Dulaglutide
  • Exenatide
  • Liraglutide
  • Lixisenatide 
  • Semaglutide
  • Tirzepatide

Sodium glucose cotransporter 2 (SGLT2) inhibitor

  • Canagliflozin
  • Dapagliflozin
  • Empagliflozin
  • Ertugliflozin

Sulfonylureas

  • Chlorpropamide
  • Glimepiride
  • Glipizide
  • Glyburide
  • Tolazamide
  • Tolbutamide

Thiazolidinediones

  • Pioglitazone
  • Rosiglitazone

Dipeptidyl peptidase-4 (DDP-4) inhibitors

  • Alogliptin
  • Linagliptin
  • Saxagliptin
  • Sitagliptin