Screening Diabetes tests for Medicare patinets

March 31st, 2009 - Codapedia Editor
Categories:   Diagnostic Testing   Preventive Medicine Service  
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The Medicare Modernization Act of 2003 added a benefit for Medicare patients for services provided after Jan 1, 2005.  Medicare added  coverage for screening Medicare patients for diabetes, if the patient has an individual risk for diabetes.  There are diagnosis and frequency limitations.

The covered tests are:

  • fasting plasma glucose test, and
  • Post-glucose challenge test

An individual with one of the following conditions is eligible:

  • Hypertension
  • Dyslipidemia
  • Obesity (BMI > 30)
  • Previous identification of elevated impaired fasting glucose or glucose intolerance

OR, and individual with two of the following risk factors for diabetes:

  • Overweight (BMI >24, but <30)
  • Family history of diabetes
  • 65 or older
  • A history of gestational diabetes, or giving birth to a baby weighing more than 9 pounds

Two screening tests per calendar year are covered for patients with pre-diabetes

One screening test per year is covered for individuals who were previously tested who were not diagnosed with pre-diabetes or who have never been tested.

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