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Reminder – Medicare Provides Coverage of Diabetes Screening Tests
July 1, 2008To ensure proper reimbursement for these screening tests the correct procedure, diagnosis codes, and modifier (when appropriate) must be used. When filing claims for diabetes screening tests the following CPT codes, and diagnosis codes must be used to ensure proper reimbursement :
HCPCS/CPT Codes and Descriptors
| HSPCS/CPT Codes | Code Descriptors |
| 82947 | Glucose; quantitative, blood (except reagent strip) |
| 82950 | Glucose; post glucose dose (includes glucose) |
| 82951 | Glucose; Tolerance Test (GTT), three specimens (includes glucose) |
Diagnosis Codes and Descriptors
| Criteria | Modifier | Diagnosis Code | Code Descriptor |
| DOES NOT MEET | None | V77.1 | To indicate that the purpose of the test(s) is for diabetes screening for a beneficiary who DOES NOT meet the *definition of pre-diabetes, screening diagnosis code V77.1 is required in the header diagnosis section of the claim. |
| MEET | -TS | V77.1 | To indicate that the purpose of the test(s) is for diabetes screening for a beneficiary who meets t he *definition of pre-diabetes, screening diagnosis code V77.1 is required in the header diagnosis section of the claim AND modifier ÒTSÓ (follow-up service) is to be reported on the line item. |
Medicare provides coverage for diabetes screening tests with the following frequency:
- Beneficiaries diagnosed with pre-diabetes Medicare provides coverage for a maximum of two diabetes screening tests per calendar year (but not less than 6 months apart) for beneficiaries diagnosed with pre-diabetes.
- Beneficiaries previously tested but not diagnosed with pre-diabetes or who have never been tested: Request Number: N/A Medicare provides coverage for one diabetes screening test per year (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 who were not diagnosed with pre-diabetes, or who have never been tested.