Introduction
Diabetes was the seventh leading cause of death in the United States in 2006. Nearly 24 million Americans have diabetes, and another 54 million are estimated to have prediabetes, increasing their risk for diabetes. Over 200,000 individuals die each year of related complications.

Millions of people have diabetes and do not know it. However, with early detection and treatment the more likely it is that the serious health consequences of diabetes can be prevented or delayed. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, expanded diabetic services covered by Medicare to include diabetes screening for beneficiaries at risk for diabetes or those diagnosed with pre-diabetes. This benefit can help improve the quality of life for Medicare beneficiaries by preventing more severe conditions that can occur without proper treatment from undiagnosed or untreated diabetes.

Risk Factors

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

What Medicare Covers

• 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 glucose for non- allenge of 75 glucose for non- pregnant adults
  OR
•  A 2-hour post-glucose challenge test alone
•  For those with pre-diabetes Medicare covers a maximum of two diabetes screening tests within a 12 month period (but not less than 6 months apart)
  

For those who are not diabetics or have not previously been diagnosed as pre-diabetics, Medicare covers one diabetes screening test within a 12 month period.

What the Physician Must Do
Provide a referral for an individual at risk for diabetes.

What the Beneficiary Pays
There is no coinsurance, copayment or deductible for this benefit.

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Related Links Inside CMS
Prevention - General Information Diabetes Screening, Supplies, and Self-Management Training
Related Links Outside CMS
National Diabetes Information Clearinghouse American Diabetes Association

Page Last Modified: 12/10/2008 3:18:58 PM
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