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CPT codes for Diabetes Screening Tests - No coinsurance or copayment

Medicare provides coverage of diabetes screening tests for beneficiaries in the risk groups previously listed or those diagnosed with
pre-diabetes. Medicare provides coverage of diabetes screening tests as a Medicare Part B benefit after a referral from a physician or qualified non-physician practitioner for a beneficiary at risk for diabetes.

Medicare provides coverage for diabetes screening tests with the following frequency:

Beneficiaries Diagnosed with Pre-Diabetes

Medicare provides coverage for a maximum of 2 diabetes screening tests within a 12-month period (but not less than 6 months apart) for beneficiaries diagnosed with pre-diabetes.

Beneficiaries Previously Tested but not Diagnosed as Pre-Diabetic or Who Have Never Been Tested

Medicare provides coverage for 1 diabetes screening test within a 12-month period (i.e., at least 11 months have passed following the month in which the last Medicare-covered diabetes screening test was performed) for beneficiaries who were previously tested and were not diagnosed with pre-diabetes, or who have never been tested.

Calculating Frequency for Diabetes Screening Tests

When calculating frequency to determine the 11-month period, the count starts beginning with the month after the month in which a previous test was performed.

FOR EXAMPLE: The beneficiary, previously tested but not diagnosed as pre-diabetic, received a diabetes screening test in January 2010. The count starts beginning February 2010. The beneficiary is eligible to receive another diabetes screening test in January 2011 (the month after 11 months have passed).

Coinsurance or Copayment and Deductible

Medicare provides coverage of diabetes screening tests as a Medicare Part B benefit. The beneficiary will pay nothing (there is no coinsurance or copayment and no Medicare Part B deductible for this benefit). Also see the complete list of CPT codes for which Co-insurance and deductible are waived.

CPT codes for Diabetes Screening Tests

82947 Glucose; quantitative, blood (except reagent strip)

82950 Glucose; post glucose dose (includes glucose)

82951 Glucose; tolerance test (GTT), three specimens (includes glucose)

Diagnosis to report Diabetes Screening Tests

Medicare providers must report ICD V77.1 - Special screening for diabetes mellitus. When a Medicare provider submits a claim for diabetes screening where the beneficiary meets the definition of pre-diabetes, the appropriate diagnosis code with modifier TS should be reported.

Please note:

The diabetes screening benefit covered by Medicare is a stand alone billable service separate from the IPPE and does not have to be obtained within a certain time frame following a beneficiary’s Medicare Part B enrollment.

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