Billing Beat

Diabetes Screen Tests

January 3, 2005

Medicare will permit coverage for the following diabetes screening tests for services performed on or after January 1, 2005 for individuals who satisfy the eligibility requirements of being at risk for diabetes:

  • Fasting plasma glucose test
  • Post-glucose challenge test

Coverage will be provided for two screening tests per calendar year for individuals diagnosed with pre-diabetes, and one screening test per year for individuals previously tested who were not diagnosed with pre-diabetes, or who have never been tested. This coverage does not apply to individuals previously diagnosed as diabetic.

Any individual with one (1) of the following individual risk factors for diabetes is eligible for this new benefit:

  • Hypertension
  • Dyslipidemia
  • Obesity (with a body mass index greater than or equal to 30 kg/m2), or
  • Previous identification of elevated impaired fasting glucose or glucose intolerance

Or, an individual with any two (2) of the following risk factors for diabetes is also eligible for this new benefit:

  • Overweight (a body mass index >25, but less than 30kg/m2)
  • A family history of diabetes
  • Age 65 years or older, or
  • A history of gestational diabetes mellitus or giving birth to a baby weighing > 9 lb

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