- Preventive Services Guide
- Medicare Preventive Services Resource Guide
- Alcohol Misuse and Counseling
- Annual Wellness Visit Screening
- Bone Mass Measurements
- Cardiovascular Disease Screening Tests
- Colorectal Cancer Screening
- Counseling to Prevent Tobacco Use
- Depression Screening
- Diabetes Screening
- Diabetes Self-Management Training
- Glaucoma Screening
- Hepatitis B Virus Screening
- Hepatitis B Virus Vaccine and Administration
- Hepatitis C Virus Screening
- Human Immunodeficiency Virus Screening
- Influenza Virus Vaccine and Administration
- Initial Preventive Physical Examination
- Intensive Behavioral Therapy for Cardiovascular Disease
- Intensive Behavioral Therapy for Obesity
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Medical Nutrition Therapy
- Pneumococcal Vaccine and Administration
- Prolonged Preventive Services
- Prostate Cancer Screening
- Screening for Cervical Cancer with Human Papillomavirus Tests
- Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
- Screening Mammography
- Screening Pap Tests
- Screening Pelvic Examinations
- Ultrasound Screening for Abdominal Aortic Aneurysm
- Vaccinations
- Related Articles
- Medicare Preventive Services Resource Guide
- The Annual Wellness Visit
- Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials
Preventive Services Guide
Diabetes Screening
Table of Contents
- Diabetes Screening
- Eligibility for Diabetes Screening
- Coverage Criteria and Frequency Limits
- HCPCS/CPT Coding
- Diagnosis Coding
- Cost Sharing
- Reimbursement
- Common Claim Denials
- Related Content
Diabetes Screening
Diabetes is diabetes mellitus, a condition of abnormal glucose metabolism diagnosed using the following criteria:
- A fasting blood sugar greater than or equal to 126 mg/dL on two different occasions
- A two hour post-glucose challenge greater than or equal to 200 mg/dL on two different occasions or
- A random glucose test over 200 mg/dL for a person with symptoms of uncontrolled diabetes
Documentation that the beneficiary is diabetic is maintained in the beneficiary’s medical record.
Eligibility for Diabetes Screening
Two eligibility categories are available, the beneficiary must have any of the following risk factors from category one, or two characteristics from category two:
Category One
- Patient has any of following risk factors:
- Hypertension
- Dyslipidemia
- Obesity (a body mass index greater than or equal to 30kg/m2)
- Previous identification of an elevated impaired fasting glucose or glucose tolerance
Category Two
- Patient has at least two of following characteristics:
- Overweight (a body mass index greater than 25 but less than 30 kg/m2)
- Family history of diabetes
- Age 65 or older
- History of gestational diabetes mellitus or delivery of baby weighing greater than nine pounds
Coverage Criteria and Frequency Limits
- Maximum of two diabetes screening tests within 12-month period
HCPCS/CPT Coding
- 82947: Glucose – quantitative, blood (except reagent strip)
- 82950: Glucose – post glucose dose (includes glucose)
- 82951: Glucose – tolerance test (GTT), three specimens (includes glucose)
- 83036: Hemoglobin; glycosylated (A1c)
Diagnosis Coding
- Z13.1
Cost Sharing
- Coinsurance waived
- Deductible waived
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers
- Nonparticipating reduction applies
- Limiting charge provision applies
Common Claim Denials
- Beneficiary not at risk for diabetes
- Beneficiary previously diagnosed with diabetes
Related Content
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter15, Section 300
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 90
- MLN® Educational Tool: Medicare Preventive Services
Revised 2/19/2024