CPT Codes For Diabetes | Descriptions & Billing Guide

Several CPT codes for diabetes can be used to describe medical treatments for diabetes. Diabetes screening can be documented with any of the following Diabetes CPT codes: CPT 82947, CPT 82950, CPT 82951, or CPT 83036. 

ICD 10 CM Z13.1 is a diabetes screening tool. CPT 82951 can be used to screen for diabetes with a tolerance test. This procedure can refer to as a “test of glucose tolerance” (GTT).  

According to Medicare guidelines, a blood glucose test is only considered medically necessary in the cases listed below. The ICD-10 CM code Z13.1 can be used to record the results of a diabetes screening (Encounter for screening for diabetes mellitus).

To get paid for this procedure, the diagnosis must be reasonable and medically necessary for the diagnosis. Therefore, the patient’s medical record should include documentation supporting the conclusion that the administered diabetic test(s) were medically necessary. 

Only one laboratory provider will pay when multiple people report the same duplicate laboratory services for a person with diabetes.

The Medicare provider must notify the appropriate diagnosis code and modifier TS. For example, CPT 82947 and CPT 82948 could not accept “Replica Laboratory Services to diagnose the hemoglobin and glucose level.

 Medicare-eligible people could diagnose with pre-diabetes or have one or more risk factors for developing diabetes.

This benefit is not available to Medicare beneficiaries diagnosed with diabetes. This test could perform in the following way:

• Pre-diabetic Medicare beneficiaries should screen twice a year.
• Medicare Beneficiary Pays
• Exemptions from copayments and coinsurance
• When a patient has pre-diabetes, add the modifier TS to Medicare claims.

Description Of The CPT Codes For Diabetes

The CPT codes for reporting diabetes-related procedures are described in CPT’s manual with CPT 82947, CPT 82950, CPT 82951, or CPT 83036 (You can find the billing guide for CPT 83036 here.)

CPT 82947: “Glucose; quantitative, blood (except reagent strip).”

TIP: You can find the complete billing guide for CPT code 82947 here.

CPT 82950: “Glucose; post glucose dose (includes glucose).

CPT 82951: “Glucose; tolerance test (GTT), three specimens (includes glucose).”

CPT 83036: “Hemoglobin; glycosylated (A1C).” You can find the billing guide for CPT 83036 here.

Several factors can be the cause for increased levels of glucose. The glucose screening benefit is available to Medicare beneficiaries who have one or more of the following diabetes risk factors:

• Hypertension
• Dyslipidemia
• Obesity can be defined as having a BMI of 30 or higher.
• Signs of impaired glucose tolerance or high fasting glucose levels

The lab analyst uses reagent strips to perform a test to measure glucose levels in the patient’s blood. Providers can help CMS better track the use of these critical services and identify areas for improvement by correctly coding for diabetes screening and other benefits.

The physician recommends HbA1c testing every three months for those with poor glucose control and those with stable glycemia every six months. The ADA guidelines could use to create interpretation bands.

In 2010, an international panel of experts recommended that an A1c cutoff of 6.5% can use to make the diagnosis beginning in 2012, and the American Diabetes Association agreed.

However, A1c tests performed at the point of care cannot be relied on for medical diagnosis due to their lack of accuracy.

Billing Guidelines

Hospitals and doctors use Current Procedural Terminology codes to describe the service(s) provided during an appointment. Medicare covers medical nutrition therapy differently than it does diabetes self-management education.

 A fasting blood glucose test, a post-glucose challenge test, and either a 2-hour post-glucose challenge test alone or an oral glucose tolerance test with a 75-gram glucose challenge could use to identify diabetic patients. The fee for this examination should pay twice a year.

 If diabetic diagnostic testing and procedures such as regular checkups are deemed medically necessary or indicated, Medicare will pay for them.

However, Medicare typically pays less than the fee plan amount and the actual invoice amount for clinical laboratory diabetic tests. Medicare typically pays less than the fee plan amount and the exact invoice for clinical diabetic laboratory tests.

Instruction on how to adjust carbohydrate-to-insulin ratios, basal rates, sick-day dosing, and insulin sensitivity-to-correction-factor settings for CSII may be a part of diabetic education.

Other possible adjustments include sick-day dosing and insulin sensitivity-to-correction-factor settings (continuous subcutaneous insulin infusion or insulin pump therapy).

The Medicare National Allowable Amount, which CMS publishes, utilizes in the computation of the fees.

You would be eligible for the benefit if you have any of the following potential risk factors:

• Abnormal high blood pressure
•  Severe lipoedema

At least two of the following items for eligibility

• Having a body mass index (BMI) less than 30 but greater than 25 kg/m2
• Diabetes runs in the family.

Those with pre-diabetes are eligible for this benefit. For example, you may be at risk for type 2 diabetes if your fasting blood sugar is between 100 and 125 mg/dL or your 2-hour glucose challenge result is between 140 and 199 mg/dL.

If these tests would order in conjunction with the diagnosis code V77.1, Medicare will cover the costs (screening for diabetes mellitus). 

How To Use Modifier 91 And Modifier TS With The CPT Codes For Diabetes

Modifier 91 can be reported with the CPT codes for Diabetes when a patient undergoes a series of laboratory diabetic tests on the same day to collect additional data to guide diabetic treatment.

It should go without saying that when billing a CPT code for diabetes for the same patient twice or even three times on the same day, the appropriate modifiers must add to each claim for the treatment and check glucose level.

Modifier 91, which can only use for laboratory tests to diagnose the glucose level, allows for the most specific billing. 

For those at risk of developing diabetes, Medicare may cover up to two yearly screenings or one every six months.

Pre-diabetes diagnosis V77.1 should include in claims for services provided through September 30, 2015; diabetes diagnosis Z131 should consist of in claims for services provided on or after October 1, 2015; and HCPCS modifier TS should include in claims for these screening services.

The general rule is that services rendered must be documented in the patient’s medical record, including patient diabetes history, regardless of the context in which each billing modifier can use.

This evidence must demonstrate more than just a clear need for medical treatment to control the level of diabetes. It must also indicate that the repeated laboratory tests for glucose could perform correctly and independently to ease the payer’s concerns.

Hyperglycemia usually resolves after the excess hormone eliminates, and this condition affects only those who already have insulin secretion problems. Therefore, it includes people who have never had a diabetes test or had a test but have not yet received a pre-diabetes diagnosis.

Medical billing has nuances that billers should be aware of when submitting claims to insurance companies. A modifier is a piece of extra information for a current procedural terminology code to claim the diabetic billing. 

Modifier 91 can use to report results from multiple diagnostic procedures performed on the same day. For example, if a patient arrives at the emergency room and a rapid glucose test reveals that he has hypoglycemia, he will need glucose gel. Another round of tests will require 15 to 20 minutes to determine whether his glucose levels have stabilized.

Only one of the two glucose tests would be covered by insurance if this hospital submitted a claim for them without a modifier.

If the hospital offered a suit with a modifier 91 on one of the glucose tests, the insurance company would know that the test was only performed once and not twice on the same day. Multiple tests could reimburse in medical billing by using modifier 91.

Modifier 91 allows for faster completion of medical billing for the CPT codes for diabetes. When billing for controlling the glucose medical services, using modifier 91 can save you a lot of time and trouble.

Applying this modifier may prevent you from having to contact the insurance company or resubmit a claim to pay the charges for glucose.

Does Medicare Cover Diabetes Screenings?

Medicare recipients at risk of developing diabetes are entitled to two free diabetes screenings yearly.

Every 12 months, Medicare covers one diabetes screening test per beneficiary. When calculating the 11-month frequency, the clock starts ticking one month after the previous test. Therefore, Medicare will cover the cost of a diabetes screening could perform at the recommended intervals.

For example, after previously testing negative for pre-diabetes, the beneficiary decided to take another test in January to ensure they did not have the condition. We’ll start keeping track in February.

The recipient is eligible for a second diabetes screening in January of the following year (the month after 11 months have passed).

Diabetes screenings could cover under Medicare Part B. The recipient could expect to pay nothing (there is no coinsurance or copayment and no Medicare Part B deductible for this benefit).

Example

An older man diagnosed with diabetic ketoacidosis underwent a series of blood tests to monitor his potassium levels after he treats with potassium replacement and low-dose insulin.

In addition to the preliminary findings regarding potassium, three additional blood tests were requested and carried out on the same day to monitor the patient’s blood levels as the potassium treatment continued.