Preventive Services: Diabetes Screening

The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Diabetes Screening: 

HCPCS/CPT Codes

ICD-10 Codes

Z13.1

Who Is Covered

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

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

Frequency

• One screening every 6 months for Medicare beneficiaries diagnosed with pre-diabetes
• One screening every 12 months if previously tested but not diagnosed with pre-diabetes or if never tested

Medicare Beneficiary Pays

• Copayment/coinsurance waived
• Deductible waived

Other Notes

• Append modifier -TS when submitting claims for Medicare beneficiaries with pre-diabetes.
• 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 your Medicare patients 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.

Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.

Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.

• CMS: Preventive Services Chart | Medicare Learning Network

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