CDC: Comprehensive Diabetes Care (multi-rate)
Multi-rate: HbA1c testing, HbA1c control (<8 / <9), nephropathy screening (urine albumin), eye exam, BP control. Each sub-rate scored separately.
Measure description
Multi-rate: HbA1c testing, HbA1c control (<8 / <9), nephropathy screening (urine albumin), eye exam, BP control. Each sub-rate scored separately.
Eligible population
Members with DM
Performance drivers
Highest-weighted Star measure for MA plans. ACO quality measure.
Documentation & PA strategy
Annual HbA1c + lipid + albumin/creatinine + dilated eye exam. Code G2161-G2167 for DM screening compliance.
Why HEDIS matters for prior authorization
Health plans align prior authorization criteria with HEDIS measures: documenting your patient meets the HEDIS definition often streamlines or eliminates PA hurdles. For Medicare Advantage in particular, plans are heavily incentivized via Star Ratings to push members and providers toward measure compliance, which translates into faster approvals for measure-aligned services.
Frequently asked questions
What does HEDIS measure CDC measure?
Multi-rate: HbA1c testing, HbA1c control (<8 / <9), nephropathy screening (urine albumin), eye exam, BP control. Each sub-rate scored separately.
What drives performance on this measure?
Highest-weighted Star measure for MA plans. ACO quality measure.
How should clinicians document for this measure?
Annual HbA1c + lipid + albumin/creatinine + dilated eye exam. Code G2161-G2167 for DM screening compliance.
What is the eligible population?
Members with DM
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