Preventive Services

Preventive Services Guide


Diabetes Screening

Table of Contents

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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.

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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:

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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

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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

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Coverage Criteria and Frequency Limits

  • Maximum of two diabetes screening tests within 12-month period

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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)

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Diagnosis Coding

  • Z13.1

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Cost Sharing

  • Coinsurance waived
  • Deductible waived

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Reimbursement

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Nonparticipating Providers

  • Nonparticipating reduction applies
  • Limiting charge provision applies

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Common Claim Denials

  • Beneficiary not at risk for diabetes
  • Beneficiary previously diagnosed with diabetes

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Related Content

Reviewed 9/27/2024