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Horizon BCBS NJMedicare Advantage · Documentation · Provider News · Endocrinology, Internal Medicine, Family Medicine +3 moreHigh impact

Statin Use in Persons with Diabetes (SUPD)

Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
Oct 3, 2026

Summary

This is a new Medicare Part D Star Ratings measure (SUPD) effective for 2026 that evaluates whether patients ages 40-75 with diabetes on antidiabetic medications are also receiving statin therapy. Billing teams must ensure proper documentation and ICD-10 coding of exclusionary diagnoses to accurately track eligible patients and avoid measure performance penalties. Claims must include appropriate exclusion codes when patients have contraindications to statin therapy.

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What to do

by Jan 1, 2026 · 6 steps
01Billing team and providers must implement the following.
02Update EMR and billing system templates to ensure annual claims submission for all qualifying diabetic patients ages 40-75 on antidiabetic medications include documentation of statin therapy status.
03When patients have medical contraindications to statins, providers MUST document and bill the appropriate ICD-10-CM exclusion codes (cirrhosis, ESRD, PCOS, prediabetes, rhabdomyolysis/myopathy, lactation, or pregnancy) on claims to properly exclude them from the SUPD measure denominator.
04Create compliance checklist in encounter forms requiring providers to document statin therapy appropriateness or document reason for exclusion.
05Train billing staff to verify presence of exclusion codes on claims for patients not on statins.
06Implement monthly reporting to track SUPD measure performance.
If missed: Failure to properly code exclusions and document statin therapy will negatively impact Medicare Star Ratings scores and plan performance metrics.

Codes mentioned

K70.30K70.31K71.7K74.3K74.4K74.5K74.60K74.69I12.0I13.11I13.2N18.5N18.6N19Z91.15Z99.2E28.2R73.03R73.09G72.0G72.89G72.9M60.80M60.819M60.829M60.839M60.849M60.859M60.869M60.879M60.9M62.82O91.03O91.13O91.23O92.03O92.13O92.5O92.70O92.79Z39.1

Original notice

Statin Use in Persons with Diabetes (SUPD)
horizonblue.com · Always check the source before changing claims.
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Related policy hubs

Horizon BCBS NJ policiesEndocrinologyInternal MedicineFamily MedicineCardiologyGeriatricsGeneral PracticeCode K70.30Code K70.31Code K71.7Code K74.3Code K74.4Code K74.5Code K74.60Code K74.69Code I12.0Code I13.11Code I13.2Code N18.5Code N18.6Code N19Code Z91.15Code Z99.2Code E28.2Code R73.03Code R73.09Code G72.0Code G72.89Code G72.9Code M60.80Code M60.819Code M60.829Code M60.839Code M60.849Code M60.859Code M60.869Code M60.879Code M60.9Code M62.82Code O91.03Code O91.13Code O91.23Code O92.03Code O92.13Code O92.5Code O92.70Code O92.79Code Z39.1

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