Diabetes is a chronic condition that affects millions of Americans, and early detection and management are essential for preventing or delaying the onset of complications. Medicare, the federal health insurance program for people who are 65 or older, people with certain disabilities, and people with end-stage renal disease, covers diabetes screening tests for eligible beneficiaries. Proper billing for diabetes screenings is important to ensure that healthcare providers receive the appropriate reimbursement for services rendered. In this article, we will discuss the Medicare diabetes screening billing guidelines and how healthcare providers can ensure proper billing for diabetes screenings.
Understanding the Medicare Diabetes Screening Benefit
The Medicare diabetes screening benefit covers diabetes screenings for eligible beneficiaries who are at risk for the disease. This includes people with high blood pressure, a family history of diabetes, or other risk factors. The benefit covers two types of diabetes screenings, including the Hemoglobin A1c test (HbA1c) and the fasting plasma glucose test (FPG). Medicare covers one HbA1c test and one FPG test per year for beneficiaries who are at risk for diabetes. Beneficiaries who have been diagnosed with diabetes are also eligible for additional screenings.
Medicare Diabetes Screening Billing Guidelines
Use the Correct Diagnostic Codes
When billing for diabetes screenings, it is important to use the correct diagnostic codes. The Current Procedural Terminology (CPT) code for the HbA1c test is 83036, and the CPT code for the FPG test is 82947. Healthcare providers should ensure that the correct CPT code is used when billing for diabetes screenings to avoid any coding errors or denials.
Bill using the Appropriate Modifier
Medicare requires the use of a modifier when billing for diabetes screenings. The modifier used is -33, which indicates that the service is preventative and is used to reduce the risk of a disease. Healthcare providers should ensure that the -33 modifier is included when billing for diabetes screenings to ensure that the service is correctly classified as preventive and eligible for coverage under Medicare.
Include all Necessary Documentation
When billing for diabetes screenings, it is important to include all necessary documentation. This includes the results of the screening test, a diagnosis for diabetes or prediabetes, and any other relevant medical information. Healthcare providers should ensure that all necessary documentation is included when billing for diabetes screenings to avoid any documentation errors or denials.
Use the Appropriate Place of Service Code
When billing for diabetes screenings, it is important to use the appropriate place of service code. The place of service code for diabetes screenings is 11 (office). Healthcare providers should ensure that the correct place of service code is used when billing for diabetes screenings to avoid any coding errors or denials.
Understand the Medicare Payment Rates
It is important to understand the Medicare payment rates for diabetes screenings. Medicare pays a different rate for each type of screening, and these rates can change each year. Healthcare providers should check the current Medicare fee schedule to ensure that the correct payment rate is being used when billing for diabetes screenings.
Bill the Correct Entity
When billing for diabetes screenings, it is important to bill the correct entity. Medicare beneficiaries may have other insurance coverage, such as a Medicare Advantage plan or a Medigap plan, that is primary to Medicare. Healthcare providers should check the beneficiary’s insurance coverage and bill the correct entity to ensure payment.
Use the Correct Diagnosis Pointer
When billing for diabetes screenings, it is important to use the correct diagnosis pointer. The diagnosis pointer for diabetes screenings is Z13.6 (encounter for screening for diabetes mellitus). Healthcare providers should ensure that the correct diagnosis pointer is used when billing for diabetes screenings to avoid any coding errors or denials.
Diabetes screenings are an important part of preventive healthcare:
Medicare covers the cost of these screenings for eligible beneficiaries who are at risk for the disease. Proper billing is essential to ensure that healthcare providers are reimbursed for the services they provide. By following the Medicare diabetes screening billing guidelines, healthcare providers can ensure that they are billing correctly and receiving proper payment for these important services.
Conclusion:
It is important for healthcare providers to stay up to date with the latest Medicare billing guidelines and to ensure that their staff is properly trained on how to bill for diabetes screenings. In addition, working with a reliable medical billing company, such as BlssMedix, can help streamline the billing process and ensure that all claims are submitted correctly and in a timely manner. By prioritizing proper billing for diabetes screenings, healthcare providers can continue to provide high-quality care to their patients and help prevent or manage diabetes and its complications.