Glycemic Status Assessment for Patient with Diabetes (GSD)
Measure Description
Percentage of Members 18-75 years of age with diabetes (DM), types 1 and 2, whose most recent glycemic status (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) was at the following levels during the measurement year: :
- Numerator 1: Glycemic Status <8.0%
- Numerator 2: Glycemic Status >9.0%
Notes
- Members are included in the denominator when they meet one of the following criteria:
- Two diagnoses of diabetes on different dates of service during the measurement year and the year prior to the measurement year.
- One diagnosis of diabetes and a dispensing event for insulin, hypoglycemic, or antihyperglycemic medication during the measurement year or the year prior to the measurement year.
- The most recent glycemic status assessment obtained during the measurement year is used for measure reporting.
- If multiple glycemic status assessments are performed on the same date, the lowest result is used.
- Glucose Management Indicator (GMI) results collected by the member and documented in the medical record are eligible for reporting when the date or date range of collection is included.
- This measure requires documentation of a glycemic status assessment result and the date of the result. Missing or incomplete documentation will assume poor glycemic status.
- For numerator 2 (HbA1c >9%), a lower rate indicates better performance.
Exclusions
- Members in hospice or received palliative care during the measurement year.
- Members who died during the measurement year.
- Members 66+ years of age with frailty and advanced illness. Members must meet BOTH the frailty and advanced illness criteria to be excluded:
- At least two indicators of frailty with different dates of service during the measurement period.
- Any of the following during the measurement year or the year prior to the measurement year:
- At least two outpatient visits, observation visits, ED visits, telephone visits, e-visits, or virtual check-ins, nonacute inpatient encounters, or nonacute inpatient discharges on different dates of service with an advanced illness diagnosis.
- At least one acute inpatient encounter with an advanced illness diagnosis.
- At least one acute inpatient discharge with an advanced illness diagnosis on the discharge claim.
- A dispensed dementia medication.
Best Practices
- Ensure HbA1c values, GMI results, and other relevant laboratory findings are entered into structured EMR fields that support quality reporting and supplemental data extraction.
- Consider leveraging EMR functionality to capture and submit appropriate Category II CPT codes to support quality measure reporting.
- Inform patients about resources available through the North Dakota Diabetes Prevention and Control Program to support diabetes self-management and prevention efforts.
- Provide comprehensive diabetes education and support for patients newly diagnosed with diabetes.
- Consider referral to a diabetes educator, care manager, or registered dietitian/nutritionist for additional education and support.
- Coordinate care with specialists, pharmacists, diabetes educators, and other providers involved in the patient's treatment plan.
- Encourage patients to bring glucose logs, continuous glucose monitoring reports, or glucose monitors to appointments for review.
- Collect, review, and document Glucose Management Indicator (GMI) results during patient encounters when available.
- Establish a systematic approach to identify and address gaps in care. Utilize EMR alerts, registries, dashboards, and reporting capabilities to track patients due for HbA1c testing and follow-up visits.
- Conduct outreach to patients with suboptimal glycemic control to encourage follow-up care, laboratory testing, medication management, and self-management support.
- Monitor missed and canceled appointments and implement outreach processes to reconnect patients with care and ensure timely follow-up.
CPT® Code HbA1c Lab Test: 83036
HbA1c CPT® Category II Codes:
HbA1c ≥ 7.0 and < 8.0 | 3051F |
HbA1c <7.0: | 3044F |
HbA1c > 9.0 | 3046F |
HbA1c ≥ 8.0 and ≤ 9.0 | 3052F |
Coding and Benefits Disclaimer
Providers and organizations must submit accurate and complete data in accordance with all billing, coding, and medical policy requirements. HEDIS guidance does not override official coding standards or guarantee reimbursement, as coverage is subject to applicable medical/coding policy and member-specific benefits.
Questions
Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.
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Updated 8/28/2026
