- Diabetes Screening
- Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy?
- Diabetes Self-Management Training
- Diabetic Self-Management Tool for Billing
- DSMT: Documentation & Physician Order Requirements
- Common Questions for Diabetes Self-Management Training and Medical Nutrition Therapy
- Common Questions for Diabetes Self-Management Program Accreditation
- Medical Nutrition Therapy
- Medical Nutrition Therapy Tool for Billing
- Common Denials Guide for Diabetes Self-Management Training and Medical Nutrition Therapy
- Medicare Diabetes Prevention Program
Preventive Services Guide
Diabetes Screening
Table of Contents
- Diabetes Screening
- Coverage Criteria and Frequency Limits
- HCPCS/CPT Coding
- Diagnosis Coding
- Cost Sharing
- Reimbursement
- Common Claim Denials
- Related Content
Diabetes Screening
Effective for claims with dates of service on or after 1/1/2024, frequency limitations for diabetes screening are restricted to not more often than twice within the 12-month period following the date of the most recent diabetes screening test of that individual for all eligible beneficiaries.
Medicare no longer distinguishes diabetes screening frequency limitations based on a prior diagnosis of pre-diabetes. The definition of pre-diabetes has been removed from diabetes screening regulatory text at 42 CFR 410.18.
Coverage Criteria and Frequency Limits
- Maximum of two diabetes screening tests within 12-month period
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)
Diagnosis Coding
- Z13.1
Cost Sharing
- Coinsurance waived
- Deductible waived
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers
- Nonparticipating reduction applies
- Limiting charge provision applies
Common Claim Denials
- Beneficiary not at risk for diabetes
- Beneficiary previously diagnosed with diabetes
Related Content
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter15, Section 300
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 90
- MLN® Educational Tool: Medicare Preventive Services
Revised 1/30/2025