Medicare diabetes screening coverage and who are eligibile - DX V77.1

Diabetes Screening

The diabetes screening tests include a fasting blood glucose test, post-glucose challenge tests, and either an oral glucose tolerance test with a glucose challenge of 75 grams of glucose for non-pregnant adults or a 2-hour post-glucose challenge test alone. This screening is covered twice within a 12-month period.

Individuals are eligible for the benefit if they have the following risk factors:

•  Hypertension.
•  Dyslipidemia.
•  Obesity (body mass index 30 kg/m2 or more).

•  Previous identification of an elevated impaired fasting glucose or glucose tolerance.
•  At least two of the following:
        o Overweight (body mass index greater than 25 kg/m2, but less than 30).
        o A family history of diabetes.
        o A history of gestational diabetes mellitus or delivery of a baby weighing greater than 9 pounds.
        o 65 years of age or older.

Patients previously diagnosed as diabetic are not covered. Individuals diagnosed as pre-diabetic are eligible for this benefit. Pre-diabetes is defined as a fasting glucose level of 100-125 mg/dL, or a 2 hour post-glucose challenge of 140-199 mg/dL. Individuals not meeting the pre-diabetes criteria are eligible for one screening test per year.

Medicare covers these tests when reported with diagnosis code V77.1 (screening for diabetes mellitus) and one of the following CPT codes:

• 82947 - Glucose; quantitative, blood (except reagent strip)
• 82950 - Glucose; post glucose dose (includes glucose)
• 82951 - Glucose; tolerance test (GTT), three specimens (includes glucose)