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This section provides resources for beneficiaries regarding the Medicare diabetes screening benefit. Effective with services provided on or after January 1, 2005, Medicare provides coverage of diabetes screening for individuals in the risk groups previously listed or those diagnosed with pre-diabetes. This new benefit will allow for earlier diagnosis for Medicare beneficiaries, which will assist in treatment and management of the disease. Who is eligible To be eligible for the diabetes screening tests beneficiaries must have any of the following risk factors or at least two of the following characteristics: Individuals are considered at risk for diabetes if they have any of the following risk factors: - Hypertension
- Dyslipidemia
- Obesity (a body mass index greater than or equal to 30kg/m2)
- Previous identification of an elevated impaired fasting glucose or glucose intolerance
OR Individuals who have a risk factor consisting of at least 2 of the following characteristics: - Overweight (a body mass index greater than 25 but less than 30kg/m2)
- Family history of diabetes
- Age 65 or older
- A history of gestational diabetes mellitus, or delivery of a baby weighing greater than 9 pounds
Pre-diabetes is a condition of abnormal glucose metabolism diagnosed from a previous fasting glucose level of 100-125mg/dL or a 2-hour post-glucose challenge of 140-199 mg/dL. The term "pre-diabetes" includes impaired fasting glucose and impaired glucose tolerance. What is covered The screening blood tests covered under Medicare include: - A fasting blood glucose test
AND - A post-glucose challenge test; not limited to an oral glucose tolerance test with a glucose challenge of 75 grams of glucose
OR - A 2 hour post-glucose challenge test alone.
Page Last Modified: 12/14/2005 9:32:00 AM
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