Part B Insider (Multispecialty) Coding Alert

Published on Sat Aug 07, 2004 PDF

Medicare will start covering diabetes screening tests next year, including a "fasting plasma glucose test" and a post-glucose challenge test (such as an oral glucose tolerance test with a glucose challenge of 75 grams of glucose, or a two-hour post-glucose challenge test alone). But since Medicare already covers random serum or plasma glucose tests for people with symptoms of uncontrolled diabetes, the screening test won't include those tests. And Medicare may start covering other diabetes screening tests via the NCD process, according to the 2005 proposed physician fee schedule.

A patient is "at risk" for diabetes, and eligible for the tests, if he has hypertension, dyslipidemia, obesity, a previous indication of an impaired glucose after fasting or impaired glucose tolerance, or two risk factors such as being overweight or having a family history of diabetes. If a patient is diagnosed with pre-diabetes, meaning a record of worrying fasting glucose or post-glucose challenge results, he'll be eligible for two screening tests per year. For other patients, the screenings will be covered once a year.

Medicare will cover the diabetes screening tests using CPT codes 82947 (Glucose; quantitative, blood [except reagent strip]) and 82951 (Glucose; tolerance test, three specimens [includes glucose]). To show that it's a screening test, the diagnosis section of the claim should include V77.1 (Special screening for diabetes mellitus).