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Expansion of Preventive Coverage of Diabetes Screening Tests for Medicare Advantage Members (Retroactively Effective 01/01/2024)


Purpose

Retroactively effective to January 1, 2024, the purpose of this document is to communicate the addition of hemoglobin A1c blood test to the preventive coverage of diabetes screening test and to update the frequency of the diabetes screening tests for Medicare Advantage members.​

Background

Screening asymptomatic adults for prediabetes and type 2 diabetes may allow earlier detection, diagnosis, and treatment, with the ultimate goal of improving health outcomes. Prediabetes and type 2 diabetes can be detected by measuring fasting plasma glucose or HbA1c level, or with an oral glucose tolerance test.

Coverage Statement

COVERAGE

Diabetes screening tests are covered as a preventive service for individuals who meet either of the following criteria:

  • The individual has any of the following risk factors:
    • Hypertension
    • Dyslipidemia
    • Obesity (a body mass index greater than or equal to 30 kg/m)
    • Previous identification of an elevated impaired fasting glucose or glucose tolerance (pre-diabetes*)
  • ​The individual has at least two of the following characteristics:
    • Overweight (a body mass index greater than 25 but less than 30 kg/m)
    • Family history of diabetes
    • Aged 65 years or older
    • A history of gestational diabetes mellitus or delivery of a baby weighing greater than 9 pounds
Diabetes screening tests for individuals previously diagnosed with diabetes are not considered a preventive service and, therefore, are not eligible for coverage under the preventive services benefit.
 
* Pre-diabetes is a condition of abnormal glucose metabolism diagnosed from a previous fasting glucose level of 100-125 mg/dL or a 2-hour post-glucose challenge of 140-199 mg/dL.
 
FREQUENCY

Diabetes screening tests are covered as preventive twice within a 12-month period. 

Coding


CPT CODES

82947 

82950 

82951 

83036  


ICD-10 DIAGNOSIS CODES

​Z13.1 Encounter for screening for diabetes mellitus

03/04/2024