Chronic kidney disease management

Applies to

Commercial group and individual plans

Medicaid and Healthy Michigan Plan 

Medical policy

Clinical practice guideline:

HEDIS measure related to CKD: 
Kidney Health Evaluation for Patients with Diabetes

  • Measure description: Members 18-85 years of age with diabetes (types 1 and 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR
  • Measure compliance: Both an eGFR and uACR test must be completed yearly

Contractors must work with providers to incorporate orders for CKD tests in routine primary care for all members with diabetes and hypertension.

Practice management links

Patient education links

Chronic kidney disease services authorizations

Prior authorization is required for many/most services. See the medical policy for details. 

Educational services billing

Payable under HMO/POS, PPO, Medicare:

  • G0420, Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour
  • G0421, Face-to-face education services related to the care of chronic kidney disease; group, per session, per one hour