Medicare AdvantageDocumentationMedium impact
Quality Considerations: Statin Use in Persons with Diabetes
EmblemHealth·Endocrinology, Family Medicine, Internal Medicine +2 more·Provider News
We identified it
Jun 20, 2026
Summary
EmblemHealth requires providers to submit claims with appropriate ICD-10 codes to exclude Medicare patients with diabetes who are not appropriate candidates for statin therapy from quality measures. This affects Medicare Star Ratings for patients ages 40-75 with diabetes.
Action Required
Immediately: When treating Medicare members with diabetes ages 40-75 who are not appropriate candidates for statin therapy, billing team must ensure claims include appropriate ICD-10 exclusion codes to remove patients from quality measures. Providers should contact EmblemHealth's clinical pharmacist at 718-938-2174 for assistance with clinically appropriate medications.