Tuesday, March 8, 2016

CPT 82947, 82950, 82951 ICD 10 Z13.1 -Diabetes screening

Diabetes Screening HCPCS/CPT Codes

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-CM Codes

Z13.1

Who Is Covered

 Medicare beneficiaries with certain risk factors for diabetes or diagnosed with pre-diabetes NOTE: Beneficiaries previously diagnosed
with diabetes are not eligible for this benefit


Frequency

• Two screening tests per year for beneficiaries diagnosed with pre-diabetes; or
• One screening per year if previously tested but not diagnosed with pre-diabetes or if never tested

Beneficiary Pays

• Copayment/coinsurance waived
• Deductible waived


*Medicare will only pay claims for DME if the ordering physician and DME supplier are actively enrolled in Medicare on the date of service. Physicians and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If you are not enrolled on the date the prescription is filled or re-filled, Medicare will not pay the submitted claims. It is also important to tell the Medicare beneficiary if you are not participating in Medicare before you order DME. If you do not have an active record, please see the following fact sheet containing information on how to enroll, revalidate your enrollment, and/or make a change:  ttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/CMS1243432.html on the CMS website.



Benefits for Treatment of Diabetes - BCBS

Benefits are available and will be determined on the same basis as any other sickness for those Medically Necessary items for Diabetes Equipment and Diabetes Supplies (for which a Physician or Professional Other Provider has written an order) and Diabetic Management Services/Diabetes Self-Management Training. Such items, when obtained for a Qualified Participant, shall include but not be limited to the following:

a. Diabetes Equipment

(1) Blood glucose monitors (including noninvasive glucose monitors and monitors for the blind);

(2) Insulin pumps (both external and implantable) and associated appurtenances, which include:

Insulin infusion devices,

Batteries,

Skin preparation items,

Adhesive supplies,

Infusion sets,

Insulin cartridges,

Durable and disposable devices to assist in the injection of insulin, and

Other required disposable supplies; and

(3) Podiatric appliances, including up to two pairs of therapeutic footwear per Calendar Year, for the prevention of complications associated with diabetes.

b. Diabetes Supplies

(1) Test strips specified for use with a corresponding blood glucose monitor

(2) Lancets and lancet devices

(3) Visual reading strips and urine testing strips and tablets which test for glucose, ketones, and protein

(4) Insulin and insulin analog preparations

(5) Injection aids, including devices used to assist with insulin injection and needleless systems

(6) Insulin syringes

(7) Biohazard disposable containers

(8) Prescriptive and non-prescriptive oral agents for controlling blood sugar levels, and

(9) Glucagon emergency kits.

c. Repairs and necessary maintenance of insulin pumps not otherwise provided for under the manufacturer's warranty or purchase agreement, rental fees for pumps during the repair and necessary maintenance of insulin pumps, neither of which shall exceed the purchase price of a similar replacement pump.


d. As new or improved treatment and monitoring equipment or supplies become available and are approved by the U. S. Food and Drug Administration (FDA), such equipment or supplies may be covered if determined to be Medically Necessary and appropriate by the treating Physician or Professional Other Provider who issues the written order for the supplies or equipment.

e. Medical-Surgical Expense provided for the nutritional, educational, and psychosocial treatment of the Qualified Participant. Such Diabetic Management Services/Diabetes Self-Management Training for which a Physician or Professional Other Provider has written an order to the Participant or caretaker of the Participant is limited to the following when rendered by or under the direction of a Physician.

Initial and follow-up instruction concerning:

(1) The physical cause and process of diabetes;

(2) Nutrition, exercise, medications, monitoring of laboratory values and the interaction of these in the effective self-management of diabetes;

(3) Prevention and treatment of special health problems for the diabetic patient;

(4) Adjustment to lifestyle modifications; and

(5) Family involvement in the care and treatment of the diabetic patient. The family will be included in certain sessions of instruction for the patient.

Diabetes Self-Management Training for the Qualified Participant will include the development of an individualized management plan that is created for and in collaboration with the Qualified Participant (and/or his or her family) to understand the care and management of diabetes, including nutritional counseling and proper use of Diabetes Equipment and Diabetes Supplies.

A Qualified Participant means an individual eligible for coverage under this Contract who has been diagnosed with (a) insulin dependent or non-insulin dependent diabetes, (b) elevated blood glucose levels induced by pregnancy, or (c) another medical condition associated with elevated blood glucose levels.


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