Medicare Expands Coverage For Screening Diabetes Testing
Medicare has expanded coverage of certain diabetes screening tests effective for services performed on or after January 1, 2005 to include:
• Fasting plasma glucose test; and
• Post-glucose challenge test (an oral glucose tolerance test with a glucose challenge of 75 grams of glucose for non-pregnant adults, or a two-hour post-glucose challenge test alone).
Any patient, not previously diagnosed as diabetic, with one 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, not previously diagnosed as diabetic, with any two of the following risk factors for diabetes is also eligible for this new benefit:
• Overweight (a body mass index >25, but<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 more than 9 pounds.
Two screening tests each calendar year are covered for individuals diagnosed with pre-diabetes. One screening test each year is covered for individuals previously tested who were not diagnosed with pre-diabetes, or who have never been tested.
These services should be billed with CPT code 82947 Glucose; quantitative, blood (except reagent strip), CPT code 82950 Glucose, post glucose dose (includes glucose), and CPT code 82951 Glucose; tolerance test (GTT), but should use V77.1 special screening for diabetes mellitus as the applicable ICD-9-CM diagnosis code to distinguish from use of these codes for the diagnostic test.
For more information, call Neil Walsh at 617-732-9377.