Diabetes is a medical condition in which your body doesn’t make enough
insulin, or has a reduced response to insulin. Diabetes causes your blood sugar
to be too high because insulin is needed to use sugar properly. A high blood
sugar level isn’t good for your health. Medicare covers a blood screening test to
check for diabetes for people at risk.
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.
82950 – Glucose; post glucose dose (includes glucose)
82951 – Glucose; tolerance test (GTT), 3 specimens (includes glucose)
ICD-10-CM (ICD-9-CM) Codes
Z13.1 (V77.1)
Who Is Covered
Medicare beneficiaries with certain risk factors for diabetes or diagnosed with pre-diabetes
NOTE: Beneficiaries previously diagnosed with diabetes are not eligible for this benefit
Frequency
Two screening tests per year for beneficiaries diagnosed with pre-diabetes; or
One screening per year if previously tested but not diagnosed with pre-diabetes or if never tested
Beneficiary Pays
Copayment/coinsurance waived
Deductible waived
Append modifier -TS when submitting claims for Medicare beneficiaries with pre-diabetes
Frequently Asked Questions (FAQs)
Am I at risk for diabetes?
You’re considered at risk if you have high blood pressure, dyslipidemia (history
of abnormal cholesterol and triglyceride levels), obesity, or a history of high
blood sugar (glucose). Medicare also covers these tests if 2 or more of these
apply to you:
Are you 65 or older?
Are you overweight?
Do you have a family history of diabetes (parents, brothers, or sisters)?
Do you have a history of gestational diabetes (diabetes during pregnancy), or have you had a baby weighing more than 9 pounds?
Other Notes
Append modifier –TS (Follow-up service) when submitting claims for Medicare beneficiaries with pre-diabetes.
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 or, in the case of the provider, have a valid opt-out affidavit on file. Tell your Medicare patients if you are not participating in Medicare before you order DME. Refer to Medicare Enrollment for Providers Who Solely Order or Certify for information on how to enroll as an ordering, certifying, or prescribing provider.