Medicare Diabetes Screening Billing Guidelines

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Medicare Diabetes Screening Billing Guidelines
Medicare Diabetes Screening Billing Medicare
Part B covers patients with certain diabetes risk
factors or diagnosed with pre-diabetes. But note
that patients previously diagnosed with diabetes
arent eligible for diabetes screening benefits.
Medicare covers 1 screening every 6 months for
patients diagnosed with pre-diabetes and 1
screening every 12 months if previously tested
but not diagnosed with pre-diabetes or if never
tested. In such screening, the patient doesnt
pay co-payment, coinsurance, or
deductibles. While billing for Medicare append
modifier TS (Follow-up service) when patients
meet the pre-diabetes definition. Medicare pays
to order providers and Durable Medical Equipment
(DME) suppliers DME claims when theyre actively
enrolled in Medicare on the service date or, in
the case of the provider, have a valid opt-out
affidavit on file. If you dont participate in
Medicare, tell your patients before you order
DME. Diabetes Screening CPT Codes Applicable
diagnosis codes and procedure codes are as
follows
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Medicare Diabetes Screening Billing Guidelines

• 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 code Z13.1. Note that additional ICD-10 co
  des may apply. Find individual Change Requests
  (CRs) and specific ICD-10-CM service codes that
  Medicare cover on the CMS ICD-10 webpage. Or you
  can refer to your MACs website for more
  information.
• Defining Primary Care Setting
• Defining the primary care setting is really
  important to get reimbursed for Medicare diabetes
  screening services. CMS defines a primary care
  setting as a place where clinicians deliver
  integrated, accessible healthcare services, are
  responsible for addressing most patient
  healthcare needs, developing a sustained patient
  partnership, and practicing in the context of
  family and community. Under this direction, CMS
  doesnt consider emergency departments, inpatient
  hospital settings, ambulatory surgical centers,
  independent diagnostic testing facilities,
  skilled nursing facilities, inpatient
  rehabilitation facilities, and hospices as
  primary care settings.

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Medicare Diabetes Screening Billing Guidelines
Medicare Diabetes Prevention Program (MDPP) The
Medicare Diabetes Prevention Program expanded
model is a structured intervention with the goal
of preventing type 2 diabetes in individuals with
an indication of prediabetes. The clinical
intervention consists of a minimum of 16
intensive core sessions of a Centers for
Disease Control and Prevention (CDC) approved
curriculum furnished over six months in a
group-based, classroom-style setting that
provides practical training in long-term dietary
change, increased physical activity, and behavior
change strategies for weight control. After
completing the core sessions, less intensive
follow-up meetings furnished monthly help ensure
that the participants maintain healthy behaviors.
The primary goal of the expanded model is at
least 5 percent weight loss by participants. The
study found that lifestyle changes resulting in
modest weight loss sharply reduced the
development of type 2 diabetes in people at high
risk for the disease. For providers or
healthcare organizations, it takes at least 12
months to obtain CDC preliminary recognition and
up to 24 additional months to achieve full
recognition. Preliminary recognition requires the
submission of 12 months of data from a National
DPP cohort.
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Medicare Diabetes Screening Billing Guidelines
Full CDC recognition requires that organizations
deliver the year-long diabetes prevention
lifestyle change program with fidelity to all CDC
Diabetes Prevention Recognition Program (DPRP)
Standards. This recognition status could be
achieved within 36 months if all requirements are
met. All requirements to achieve CDC Full
Recognition status are listed in the CDC DPRP
standards and include using a CDC-approved
curriculum, meeting attendance-based
requirements, and meeting standards related to
the rate at which participants achieve the final
5 percent or more weight loss goal. Medical
Billers and Coders (MBC) is a leading medical
billing company providing complete medical
billing and coding services. To explain Medicare
diabetes screening billing guidelines we referred
to the CMS webpage for Medicare Preventive
Services and Medicare Diabetes Prevention Program
(MDPP) for a detailed understanding. To receive
accurate reimbursement from Medicare, Medicaid,
and other private insurance carriers, email us
at info_at_medicalbillersandcoders.com or call
us 888-357-3226.