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.

Who Is Covered

Medicare beneficiaries with certain risk factors for diabetes or diagnosed with pre-diabetes

   • High blood pressure (hypertension)

   • History of abnormal cholesterol and triglyceride levels (dyslipidemia)

   • Obesity

   •  History of high blood sugar (glucose)

   • Age 65 or older

   • Overweight

   • Family history of diabetes (parents, brothers, sisters)

   • History of gestational diabetes (diabetes during pregnancy), or delivery of a baby weighing more than 9 pounds

Note: Medicare beneficiaries previously diagnosed with diabetes are not eligible for this benefit

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-CM Codes

Z13.1

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 waived

   • Coinsurance waived

   • Deductible waived

   Note: Append modifier -TS when submitting claims for Medicare beneficiaries with pre-diabetes

References