Medicare AdvantageDocumentationMedium impact
AB2026-04-002 Medicare only
Capital Blue Cross·Family Medicine, Internal Medicine, Endocrinology +1 more·Provider News
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
Capital Blue Cross updated Medicare Part D Star measures for 2026, adding new exclusions for Statin Use in Persons with Diabetes (SUPD) that recognize PCSK9 inhibitors and bempedoic acid as alternatives for patients who cannot tolerate statins. Providers must submit specific ICD-10-CM codes annually during in-person or audio/video visits to qualify patients for exclusions from the SUPD measure.
Action Required
Immediately: Providers must document qualifying SUPD exclusion conditions annually during in-person or audio/video visits using the specified ICD-10-CM codes. Update EMR templates to include the new exclusion codes for cirrhosis, end-stage renal disease, pregnancy/lactation, PCOS, pre-diabetes, and statin-related adverse effects. Billing team should flag diabetic patients ages 40-75 to ensure proper coding for Star measure compliance.