Bienvenidos, Corredores!

Diabetes is the leading cause of chronic kidney disease affecting almost one in three people. Clinical guidelines recommend that all people with diabetes have routine tests to detect kidney disease. However, less than half get the needed tests. 

Kidney disease does not show symptoms until later stages of the disease, and this makes early detection the key to managing the disease appropriately. The Kidney Health Evaluation (KED) assesses both kidney function with an estimated glomerular filtration rate (eGFR) and kidney damage with a urine albumin-creatinine (uACR) to develop an appropriate treatment plan.

What do you need to do?

• Order both an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR).
• Submit claims (CPT, CPT II codes, etc.) and encounter data in a timely manner, including diagnosis codes.

The suggested codes for these measures are:

• Estimated Glomerular Filtration Rate (eGFR): 80047, 80048, 80050, 80053, 80069 and 82565.
• Urine Albumin-Creatinine Ratio (uACR): 82043 AND 82570 Please note: if the urine albumin and the urine creatinine tests are ordered separately, they must be completed within four calendar days of each other.

Please be aware: Procedure code 82044 to report the uACR was retired by NCQA in 2022 and should not be reported.

Please note: if you have been using 82044 to report the service, you do not need to resubmit a corrected claim. You can simply provide a copy of the lab results to Fidelis Care or Wellcare. 

For Fidelis Care, you can submit via any of the following:

• Email: QMGMRO@fideliscare.org,
• Upload to your M365 account

For Wellcare, you can upload the lab results to via the Wellcare Provider Portal following normal submission of medical records.