Applies to members of:

Commercial group and individual plans

Medicaid and Healthy Michigan Plan

Definition

Chronic kidney disease is the progressive loss of kidney function over time, leading eventually to kidney failure.

Medical policy

End-stage Renal Disease (ESRD) - 91526

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.

Medicaid services available to help in early diagnosis of Chronic Kidney Disease (CKD) for your patients. 

Practice management links

CKDintercept program from the National Kidney Foundation 

Clinician tools offered through the National Kidney Foundation

Patient education links

CKD information and treatment options for patients from Emmi^®

• To use Emmi, simply enter the patient first and last name, DOB, and email address.

Patient education resources offered through the National Kidney Foundation

Are you part of the 33%? This quiz, offered through the National Kidney Foundation, can help patients assess and understand their risk for CKD. 

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