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Pathology/Lab Coding Alert

Medicare Screens All Patients With Diabetes Risk

Published on Fri Apr 01, 2005

But pre-diabetes means more frequent testing 

Medicare's annual screening coverage applies to those at risk for developing diabetes, says Maggie Mac, a healthcare consultant with Pershing, Yoakley & Associates in Clearwater, Fla. Medicare says it will consider patients to be "at risk" if they present with at least one of the following conditions:

  •  hypertension

  •  dyslipidemia

  •  obesity (a body mass index equal to or greater than 30 kg/m2)

  •  previously identified elevated fasting glucose or glucose intolerance.

    Or, individuals who have at least two of the following characteristics are eligible for Medicare's diabetes screening benefit:

  •  overweight (a body mass index greater than 25, but less than 30 kg/m2)

  •  a family history of diabetes

  •  age 65 years or older

  •  a history of gestational diabetes mellitus, or delivering a baby weighing more than nine pounds.

    Pre-Diabetes Means Rescreening at 6 Months

    Your lab can get paid for two screening tests per year for individuals diagnosed with pre-diabetes. Otherwise, Medicare only covers one screening per year. Pre-diabetes means that the patient exhibits impaired fasting glucose or impaired glucose tolerance. Medicare specifically defines pre-diabetes as a fasting glucose level of 100 to 125 mg/dL, or a 2-hour post-glucose challenge of 140 to 199 mg/dL.

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