Diabetes screening can be reported with CPT 82947, CPT 82950, CPT 82951, and CPT 83036. ICD ICD-10 CM Z13.1 can be used for screening for diabetes. Reimbursement and the descriptions of the codes can be found below.
CPT Codes For Diabetes Screening Tests
The following CPT codes be used to report diabetes screening tests.
82947 CPT Code Description
CPT 82947 is defined as: “Glucose; quantitative, blood. Except reagent strip”.
82950 CPT Code Description
CPT 82950 can be used to report glucose and is defined as: “Glucose; post glucose dose. Includes glucose”.
82951 CPT Code Description
Report CPT 82951 for a tolerance test for diabetes screening. It is defined as: “Glucose. Tolerance test (GTT). Three specimens includes glucose.”
83036 CPT Code Description
Hemoglobin (A1C) can be billed with CPT 83036 and is defined by the manual as: “Hemoglobin A1C”.
Screening For Diabetis ICD 10
Use ICD ICD-10 CM Z13.1 (Encounter for screening for diabetes mellitus) to report screening for diabetes. 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.
Reimbursement For Diabetes Screening Tests
Medicare provides coverage for diabetes screening tests with the following frequency.
Medicare provides coverage for a maximum of 2 diabetes screening tests within 12 months (but not less than six months apart) for beneficiaries diagnosed with pre-diabetes.
Medicare provides coverage for one diabetes screening test within 12 months (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.
When calculating frequency to determine the 11-month period, the count starts with the month after the previous test was performed.
FOR EXAMPLE, The beneficiary, previously tested but not diagnosed as pre-diabetic, received a diabetes screening test in January. The count starts beginning February. The beneficiary is eligible to receive another diabetes screening test in January of the following year (the month after 11 months have passed).
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).
A Last Note
The diabetes screening benefit covered by Medicare is a stand-alone billable service separate from the IPPE. It does not have to be obtained within a specific time frame following a beneficiary’s Medicare Part B enrollment.