Diabetes Screening
Medicare only pays claims for Durable Medicare Equipment (DME) if the ordering provider and DME supplier are actively enrolled in Medicare on the date of service. Tell the Medicare beneficiary if you are not participating in Medicare before you order DME. Refer to “Medicare Enrollment Guidelines for Ordering/Referring Providers” for information on how to enroll as an ordering/referring provider.
HCPCS/CPT Codes
82947 – Glucose; quantitative, blood (except reagent strip)
82950 – Glucose; post glucose dose (includes glucose)
82951 – Glucose; tolerance test (GTT), 3 specimens (includes glucose)
ICD-10 Codes
Z13.1
Who Is Covered
Medicare beneficiaries with certain risk factors for diabetes or diagnosed with pre-diabetes
NOTE: Medicare beneficiaries previously diagnosed with diabetes are not eligible for this benefit Frequency
* Two screening tests per year for Medicare beneficiaries diagnosed with pre-diabetes
* One screening per year if previously tested but not diagnosed with pre-diabetes or if never tested
Medicare Beneficiary Pays
* Copayment/coinsurance waived
* Deductible waived
Append modifier -TS when submitting claims for Medicare beneficiaries with pre-diabetes
CPT Code: 82947 Blood Glucose Testing
Frequency Limitations: In stable, non-hospitalized patients who are unable or unwilling to do home glucose monitoring, it may be reasonable and necessary to measure quantitative blood glucose up to 4 times annually.
Depending on the age and condition of the patient, the type of diabetes, degree of control, and other co-morbid conditions, more frequent testing may be reasonable and necessary.
Billing and Coding Guidelines
CPT 82947 Glucose, quantitative, blood, (except reagent strip)
CPT CODE 82947, 82950 and 82951 when billed with diagnosis code V77.1O utpatient Code Editor 3637.6 The CWF shall allow codes 82947 and 82951 no more than once every 6 months when billed with diagnosis code V77.1 X 3637.7 Contractors shall deny claims for 82947 and 82951 upon receipt of a CWF reject that indicates the dates of service are more frequent than 2 screening tests per year for individuals diagnosed with pre-diabetes.
The NCD Edit Module for Clinical Diagnostic Laboratory Services shall be revised. CPT code 82947, when billed with diagnosis code V77.1, shall be listed as a covered ICD-9 code.
Same Group Physician or Other Health Care Professional
Only one laboratory service is reimbursable when Duplicate Laboratory Services are submitted from the Same Group Physician or Other Health Care Professional. CPT codes 82947 and 82948 are excluded from Duplicate Laboratory Services.
Separate consideration will be given to repeat procedures (i.e., two laboratory procedures performed the same day) by the Same Group Physician or Other Health Care Professional when reported with modifier 91. Modifier 91 is appropriate when the repeat laboratory service is performed by a different individual in the same group with the same Federal Tax Identification number
Multiple Physicians or Other Health Care Professionals
Only one laboratory provider will be reimbursed when multiple individuals report Duplicate Laboratory Services. Multiple individuals may include, but are not limited to, any physician or other health care professional, Reference Laboratory, Referring Laboratory or pathologist reporting duplicate services. CPT codes 82947 and 82948 are excluded from Duplicate Laboratory Services.
The following CPT codes are used to bill for Medicare diabetes screening tests:
— 82947: glucose, quantitative, blood (except reagent strip);
— 82950: glucose, post glucose does (includes glucose); and
— 82951: glucose, tolerance test (GTT), 3 specimens, (includes glucose).
• Screening tests performed for pre-diabetic patients must be identified by use of the TS modifier (follow-up service).
• Diagnosis code V77.1 (special screening for endocrine, nutritional, metabolic and immunity disorders, diabetes mellitus) must be used as the diagnosis for Medicare screening diabetes tests.
• All of the above test codes are included in the Medicare Laboratory Fee Schedule. Medicare reimbursement for a glucose test is $5.48. No patient copay applies to tests on the Medicare Laboratory Fee Schedule.
ICD 10 CODE
• Z13.1 Encounter for screening for
diabetes mellitus
Z13.220 Encounter for screening
for lipid disorders
• Z13.1 Encounter for screening for
diabetes mellitus
• Z01.411 Encounter for gynecological examination (general)
(routine) with abnormal findings
• Z01.419 Encounter for
gynecological examination (general)
(routine) without abnormal findings
• Z12.72 Encounter for screening for
malignant neoplasm of vagina
• Z12.4 Encounter for screening for
malignant neoplasm of cervix
• Z13.220 Encounter for screening
for lipid disorders
• Z13.1 Encounter for screening for
diabetes mellitus
ICD-9 Codes are associated with CPT code 82947 in this policy.
The Blood Glucose Testing is determined to be medically necessary by Medicare only when it is ordered for patients with one of the conditions listed below. ICD-9-CM codes that support medical necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-9-CM code. The diagnosis must be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patient’s medical record must support the medical necessity for the test(s) provided.
| 011.00 | Tuberculosis of lung, infiltrative, unspecified |
| 011.01 | Tuberculosis of lung, infiltrative, bacteriological or histological examination not done |
| 011.02 | Tuberculosis of lung, infiltrative, bacteriological or histological examination unknown (at present) |
| 011.03 | Tuberculosis of lung, infiltrative, tubercle bacilli found (in sputum) by microscopy |
| 011.04 | Tuberculosis of lung, infiltrative, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture |
| 011.05 | Tuberculosis of lung, infiltrative, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically |
| 011.06 | Tuberculosis of lung, infiltrative, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods |
| 011.10 | Tuberculosis of lung, nodular, unspecified |
| 011.11 | Tuberculosis of lung, nodular, bacteriological or histological examination not done |
| 011.12 | Tuberculosis of lung, nodular, bacteriological or histological examination unknown (at present) |
…. and many more.
