Clinical Pathology Laboratories (CPL) is pleased to announce that the Centers for Medicare & Medicaid Services (CMS) has finalized a rule to expand coverage of diabetes screening tests for Medicare beneficiaries to include the HbA1C test:
- In the 2024 Medicare Physician Fee Schedule Final Rule, covered diabetes screening has been expanded to simplify the definition of “diabetes” in screening which allows more Medicare beneficiaries to be eligible, as well as increase the frequency and methodology of testing allowed.
- The expansion adds HbA1C as a covered diabetes screening test, along with the already covered fasting plasma glucose test and glucose tolerance test. HbA1C does not require fasting so it may be more convenient than either of the previously covered tests.
- CMS will now allow screening tests including HbA1C up to twice every 12 months for all* Medicare beneficiaries.
Prior to CMS’ new regulation, diabetes screening has only been covered twice a year for patients diagnosed with prediabetes. CMS only covered one test every 12 months for patients without a diagnosis of diabetes.
| Hemoglobin A1C | 2708 | 83036 |
| Hemoglobin A1C with eAG and Interpretation Chart |
2707 | 83036 |
| Hemoglobin A1C with eAG | 2709 | 83036 |
| Name | Test Code | CPT Code |
|---|
*Medicare covers Part B Patients with certain diabetes risk factors or who have been diagnosed with pre-diabetes, patients previously diagnosed with diabetes not eligible
For ICD-10-CM coverage guidance, visit: https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html#DIABETES