Blood glucose determination may be done using whole blood, serum or plasma. It may be sampled by capillary puncture, as in the finger stick method, or by vein puncture or arterial sampling.
| Medicare Advantage Medical Policy |
| Medical Policy: | N-236-004 |
| Topic: | Blood Glucose Testing and Diabetes Screening - NCD 190.20 |
| Section: | CMS National Guidelines |
| Effective Date: | January 1, 2017 |
| Issue Date: | March 6, 2017 |
| Last Reviewed: | February 2017 |
Blood glucose determination may be done using whole blood, serum or plasma. It may be sampled by capillary puncture, as in the finger stick method, or by vein puncture or arterial sampling.
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
| Policy Position Coverage is subject to the specific terms of the member’s benefit plan. |
To view specific LCD and NCD information, as well as other CMS sources, please refer to the LINKS section at the bottom of this policy page.
82947* 82948 82950* 82951* 82962
*Diabetic screening
Diagnosis Code Section
ICD-9 Diagnosis Codes
Covered Diagnosis Codes
011.00 011.02 011.03 011.04 011.05 011.06 011.10 011.11 011.12 011.13 011.14 011.15 011.16 011.20 011.21 011.22 011.23 011.24 011.25 011.26 011.30 011.31 011.32 011.33 011.34 011.35 011.36 011.40 011.41 011.42 011.43 011.44 011.45 011.46 011.50 011.51 011.52 011.53 011.54 011.55 011.56 011.60 011.61 011.62 011.63 011.64 011.65 011.66 011.70 011.71 011.72 011.73 011.74 011.75 011.76 011.80 011.81 011.82 011.83 011.84 011.85 011.86 011.90 011.91 011.92 011.93 011.94 011.95 011.96 038.0 038.2 038.3 038.4 038.8 038.9 038.10 038.11 038.12 038.19 038.40 038.41 038.42 038.43 038.44 038.49 112.1 112.3 118 157.4 158.0 211.7 242.00 242.01 242.10 242.11 242.20 242.21 242.30 242.31 242.40 242.41 242.80 242.81 242.90 242.91 249.00 249.01 249.10 249.11 249.20 249.21 249.30 249.31 249.40 249.41 249.50 249.51 249.60 249.61 249.70 249.71 249.80 249.81 249.90 249.91 250.00 250.01 250.02 250.03 250.10 250.11 250.12 250.13 250.20 250.21 250.22 250.23 250.30 250.31 250.32 250.33 250.40 250.41 250.42 250.43 250.50 250.51 250.52 250.53 250.60 250.61 250.62 250.63 250.70 250.71 250.72 250.73 250.80 250.81 250.82 250.83 250.90 250.91 250.92 250.93 251.0 251.1 251.2 251.3 251.4 251.5 251.8 251.9 253.0 253.1 253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9 255.0 263.0 263.1 263.2 263.8 263.9 271.0 271.1 271.2 271.3 271.4 271.8 271.9 272.0 272.1 272.2 272.4 273.3 275.01 275.02 275.03 275.09 276.0 276.1 276.2 276.3 276.4 276.7 276.8 276.9 276.50 276.51 276.52 276.61 276.69 278.3 293.0 294.9 298.9 300.9 310.1 331.83 337.9 345.10 345.11 348.31 355.9 356.9 357.9 362.9 362.10 362.18 362.29 362.50 362.51 362.52 362.53 362.54 362.55 362.56 362.57 362.60 362.61 362.62 362.63 362.64 362.65 362.66 362.81 362.82 362.83 362.84 362.85 362.89 365.04 365.32 366.00 366.01 366.02 366.03 366.04 366.09 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17 366.18 366.19 367.1 368.8 373.00 377.9 377.24 378.50 378.51 378.52 378.53 378.54 378.55 379.45 410.00 410.01 410.02 410.10 410.11 410.12 410.20 410.21 410.22 410.30 410.31 410.32 410.40 410.41 410.42 410.50 410.51 410.52 410.60 410.61 410.62 410.70 410.71 410.72 410.80 410.81 410.82 410.90 410.91 410.92 414.3 414.4 414.00 414.01 414.02 414.03 414.04 414.05 414.06 414.07 414.10 414.11 414.12 414.19 425.9 440.9 440.23 440.24 458.0 462 466.0 480.0 480.1 480.2 480.3 480.8 480.9 481 482.0 482.1 482.2 482.9 482.30 482.31 482.32 482.39 482.40 482.41 482.42 482.49 482.81 482.82 482.83 482.84 482.89 483.0 483.1 483.8 484.1 484.3 484.5 484.6 484.7 484.8 485 486 490 491.0 491.1 491.8 491.9 491.20 491.21 491.22 527.7 528.00 528.09 535.50 535.51 536.8 571.8 572.0 572.1 572.2 572.3 572.4 572.8 574.50 574.51 575.0 575.10 575.11 575.12 576.1 577.0 577.1 577.8 590.2 590.3 590.9 590.00 590.01 590.10 590.11 590.80 590.81 595.9 596.4 596.53 599.0 607.84 608.89 616.10 626.0 626.4 628.9 648.00 648.03 648.04 648.80 648.83 648.84 649.20 649.21 649.22 649.23 649.24 656.60 656.61 656.63 657.00 657.01 657.03 680.0 680.1 680.2 680.3 680.4 680.5 680.6 680.7 680.8 680.9 686.9 686.00 686.01 698.0 698.1 704.1 705.0 707.8 707.9 707.00 707.01 707.02 707.03 707.04 707.05 707.06 707.07 707.09 707.10 707.11 707.12 707.13 707.14 707.15 707.20 707.21 707.22 707.23 707.24 707.25 709.3 729.1 730.07 730.17 730.27 780.2 780.4 780.8 780.01 780.02 780.09 780.31 780.32 780.33 780.39 780.71 780.72 780.79 781.0 782.0 783.1 783.5 783.6 783.21 785.0 785.4 786.01 786.09 786.50 787.60 787.61 787.62 787.63 787.91 788.41 788.42 788.43 789.1 790.6 790.21 790.22 790.29 791.0 791.5 796.1 799.4 V23.0 V23.9 V58.63 V58.64 V58.65 V58.67 V58.69 V67.2 V67.51
Covered Diagnosis Code for procedure codes 82947, 82950, and 82951 ONLY
V77.1
ICD-10 Diagnosis Codes
Covered Diagnosis Codes for Procedure Codes 82948, 82962
A15.0 A15.5 A22.1 A37.01 A37.11 A37.81 A37.91 A40.0 A40.1 A40.3 A40.8 A40.9 A41.01 A41.02 A41.1 A41.2 A41.3 A41.4 A41.50 A41.51 A41.52 A41.53 A41.59 A41.81 A41.89 A41.9 A42.7 A48.1 B25.0 B25.2 B37.2 B37.3 B44.0 B48.8 B77.81 B78.1 C25.4 C48.0 D13.7 E03.5 E05.00 E05.01 E05.10 E05.11 E05.20 E05.21 E05.30 E05.31 E05.40 E05.41 E05.80 E05.81 E05.90 E05.91 E08.00 E08.01 E08.10 E08.11 E08.21 E08.22 E08.29 E08.311 E08.319 E08.3211 E08.3212 E08.3213 E08.3219 E08.3291 E08.3292 E08.3293 E08.3299 E08.3311 E08.3312 E08.3313 E08.3319 E08.3391 E08.3392 E08.3393 E08.3399 E08.3411 E08.3412 E08.3413 E08.3419 E08.3491 E08.3492 E08.3493 E08.3499 E08.3511 E08.3512 E08.3513 E08.3519 E08.3591 E08.3592 E08.3593 E08.3599 E08.36 E08.39 E08.40 E08.41 E08.42 E08.43 E08.44 E08.49 E08.51 E08.52 E08.59 E08.610 E08.618 E08.620 E08.621 E08.622 E08.628 E08.630 E08.638 E08.641 E08.649 E08.65 E08.69 E08.8 E08.9 E09.00 E09.01 E09.10 E09.11 E09.21 E09.22 E09.29 E09.311 E09.319 E09.3211 E09.3212 E09.3213 E09.3219 E09.3291 E09.3292 E09.3293 E09.3299 E09.3311 E09.3312 E09.3313 E09.3319 E09.3391 E09.3392 E09.3393 E09.3399 E09.3411 E09.3412 E09.3413 E09.3419 E09.3491 E09.3492 E09.3493 E09.3499 E09.3511 E09.3512 E09.3513 E09.3519 E09.3591 E09.3592 E09.3593 E09.3599 E09.36 E09.39 E09.40 E09.41 E09.42 E09.43 E09.44 E09.49 E09.51 E09.52 E09.59 E09.610 E09.618 E09.620 E09.621 E09.622 E09.628 E09.630 E09.638 E09.641 E09.649 E09.65 E09.69 E09.8 E09.9 E10.10 E10.11 E10.21 E10.22 E10.29 E10.311 E10.319 E10.3211 E10.3212 E10.3213 E10.3219 E10.3291 E10.3292 E10.3293 E10.3299 E10.3311 E10.3312 E10.3313 E10.3319 E10.3391 E10.3392 E10.3393 E10.3399 E10.3411 E10.3412 E10.3413 E10.3419 E10.3491 E10.3492 E10.3493 E10.3499 E10.3511 E10.3512 E10.3513 E10.3519 E10.3591 E10.3592 E10.3593 E10.3599 E10.36 E10.39 E10.40 E10.41 E10.42 E10.43 E10.44 E10.49 E10.51 E10.52 E10.59 E10.610 E10.618 E10.620 E10.621 E10.622 E10.628 E10.630 E10.638 E10.641 E10.649 E10.65 E10.69 E10.8 E10.9 E11.00 E11.01 E11.21 E11.22 E11.29 E11.311 E11.319 E11.3211 E11.3212 E11.3213 E11.3219 E11.3291 E11.3292 E11.3293 E11.3299 E11.3311 E11.3312 E11.3313 E11.3319 E11.3391 E11.3392 E11.3393 E11.3399 E11.3411 E11.3412 E11.3413 E11.3419 E11.3491 E11.3492 E11.3493 E11.3499 E11.3511 E11.3512 E11.3513 E11.3519 E11.3591 E11.3592 E11.3593 E11.3599 E11.36 E11.39 E11.40 E11.41 E11.42 E11.43 E11.44 E11.49 E11.51 E11.52 E11.59 E11.610 E11.618 E11.620 E11.621 E11.622 E11.628 E11.630 E11.638 E11.641 E11.649 E11.65 E11.69 E11.8 E11.9 E13.00 E13.01 E13.10 E13.11 E13.21 E13.22 E13.29 E13.311 E13.319 E13.3211 E13.3212 E13.3213 E13.3219 E13.3291 E13.3292 E13.3293 E13.3299 E13.3311 E13.3312 E13.3313 E13.3319 E13.3391 E13.3392 E13.3393 E13.3399 E13.3411 E13.3412 E13.3413 E13.3419 E13.3491 E13.3492 E13.3493 E13.3499 E13.3511 E13.3512 E13.3513 E13.3519 E13.3591 E13.3592 E13.3593 E13.3599 E13.36 E13.39 E13.40 E13.41 E13.42 E13.43 E13.44 E13.49 E13.51 E13.52 E13.59 E13.610 E13.618 E13.620 E13.621 E13.622 E13.628 E13.630 E13.638 E13.641 E13.649 E13.65 E13.69 E13.8 E13.9 E15 E16.0 E16.1 E16.2 E16.3 E16.4 E16.8 E16.9 E22.0 E22.1 E22.2 E22.8 E22.9 E23.0 E23.1 E23.2 E23.3 E23.6 E23.7 E24.0 E24.1 E24.2 E24.3 E24.4 E24.8 E24.9 E34.4 E44.0 E44.1 E45 E46 E64.0 E67.1 E72.52 E72.53 E73.0 E73.1 E73.8 E73.9 E74.00 E74.01 E74.02 E74.03 E74.04 E74.09 E74.10 E74.11 E74.12 E74.19 E74.20 E74.21 E74.29 E74.31 E74.39 E74.4 E74.8 E74.9 E77.1 E78.00 E78.01 E78.1 E78.2 E78.3 E78.4 E78.5 E79.0 E83.10 E83.110 E83.111 E83.118 E83.119 E83.19 E83.2 E86.0 E86.1 E86.9 E87.0 E87.1 E87.2 E87.3 E87.4 E87.5 E87.6 E87.70 E87.71 E87.79 E87.8 E89.1 E89.3 F05 F06.8 F07.0 F28 F29 F48.9 F99 G31.84 G40.309 G40.311 G40.319 G40.401 G40.409 G40.411 G40.419 G58.8 G58.9 G59 G60.9 G61.9 G62.9 G90.2 G90.8 G90.9 G93.3 G93.41 H01.001 H01.002 H01.003 H01.004 H01.005 H01.006 H01.009 H25.011 H25.012 H25.013 H25.019 H25.031 H25.032 H25.033 H25.039 H25.041 H25.042 H25.043 H25.049 H25.091 H25.092 H25.093 H25.099 H25.10 H25.11 H25.12 H25.13 H25.20 H25.21 H25.22 H25.23 H25.811 H25.812 H25.813 H25.819 H25.89 H25.9 H26.001 H26.002 H26.003 H26.009 H26.011 H26.012 H26.013 H26.019 H26.031 H26.032 H26.033 H26.039 H26.041 H26.042 H26.043 H26.049 H26.051 H26.052 H26.053 H26.059 H26.061 H26.062 H26.063 H26.069 H26.09 H35.00 H35.061 H35.062 H35.063 H35.069 H35.20 H35.21 H35.22 H35.23 H35.30 H35.3110 H35.3111 H35.3112 H35.3113 H35.3114 H35.3120 H35.3121 H35.3122 H35.3123 H35.3124 H35.3130 H35.3131 H35.3132 H35.3133 H35.3134 H35.3190 H35.3191 H35.3192 H35.3193 H35.3194 H35.3210 H35.3211 H35.3212 H35.3213 H35.3220 H35.3221 H35.3222 H35.3223 H35.3230 H35.3231 H35.3232 H35.3233 H35.3290 H35.3291 H35.3292 H35.3293 H35.341 H35.342 H35.343 H35.349 H35.351 H35.352 H35.353 H35.359 H35.361 H35.362 H35.363 H35.369 H35.371 H35.372 H35.373 H35.379 H35.381 H35.382 H35.383 H35.389 H35.40 H35.411 H35.412 H35.413 H35.419 H35.421 H35.422 H35.423 H35.429 H35.431 H35.432 H35.433 H35.439 H35.441 H35.442 H35.443 H35.449 H35.451 H35.452 H35.453 H35.459 H35.461 H35.462 H35.463 H35.469 H35.60 H35.61 H35.62 H35.63 H35.81 H35.82 H35.89 H35.9 H40.051 H40.052 H40.053 H40.059 H40.60X0 H40.60X1 H40.60X2 H40.60X3 H40.60X4 H40.61X0 H40.61X1 H40.61X2 H40.61X3 H40.61X4 H40.62X0 H40.62X1 H40.62X2 H40.62X3 H40.62X4 H40.63X0 H40.63X1 H40.63X2 H40.63X3 H40.63X4 H47.331 H47.332 H47.333 H47.339 H47.9 H49.00 H49.01 H49.02 H49.03 H49.10 H49.11 H49.12 H49.13 H49.20 H49.21 H49.22 H49.23 H49.40 H49.41 H49.42 H49.43 H49.881 H49.882 H49.883 H49.889 H49.9 H52.10 H52.11 H52.12 H52.13 H53.71 H53.72 H53.8 H57.01 I21.01 I21.02 I21.09 I21.11 I21.19 I21.21 I21.29 I21.3 I21.4 I22.0 I22.1 I22.2 I22.8 I22.9 I25.10 I25.110 I25.111 I25.118 I25.119 I25.3 I25.41 I25.42 I25.700 I25.701 I25.708 I25.709 I25.710 I25.711 I25.718 I25.719 I25.720 I25.721 I25.728 I25.729 I25.730 I25.731 I25.738 I25.739 I25.750 I25.751 I25.758 I25.759 I25.760 I25.761 I25.768 I25.769 I25.790 I25.791 I25.798 I25.799 I25.810 I25.811 I25.812 I25.83 I25.84 I42.7 I42.9 I70.231 I70.232 I70.233 I70.234 I70.235 I70.238 I70.239 I70.241 I70.242 I70.243 I70.244 I70.245 I70.248 I70.249 I70.25 I70.261 I70.262 I70.263 I70.268 I70.269 I70.331 I70.332 I70.333 I70.334 I70.335 I70.338 I70.339 I70.341 I70.342 I70.343 I70.344 I70.345 I70.348 I70.349 I70.35 I70.361 I70.362 I70.363 I70.368 I70.369 I70.431 I70.432 I70.433 I70.434 I70.435 I70.438 I70.439 I70.441 I70.442 I70.443 I70.444 I70.445 I70.448 I70.449 I70.45 I70.461 I70.462 I70.463 I70.468 I70.469 I70.531 I70.532 I70.533 I70.534 I70.535 I70.538 I70.539 I70.541 I70.542 I70.543 I70.544 I70.545 I70.548 I70.549 I70.55 I70.561 I70.562 I70.563 I70.568 I70.569 I70.631 I70.632 I70.633 I70.634 I70.635 I70.638 I70.639 I70.641 I70.642 I70.643 I70.644 I70.645 I70.648 I70.649 I70.65 I70.661 I70.662 I70.663 I70.668 I70.669 I70.731 I70.732 I70.733 I70.734 I70.735 I70.738 I70.739 I70.741 I70.742 I70.743 I70.744 I70.745 I70.748 I70.749 I70.75 I70.761 I70.762 I70.763 I70.768 I70.769 I70.90 I70.91 I73.01 I95.1 I96 J02.8 J02.9 J12.0 J12.1 J12.2 J12.3 J12.81 J12.89 J12.9 J13 J14 J15.0 J15.1 J15.20 J15.211 J15.212 J15.29 J15.3 J15.4 J15.5 J15.6 J15.7 J15.8 J15.9 J16.0 J16.8 J17 J18.0 J18.1 J18.8 J18.9 J20.0 J20.1 J20.2 J20.3 J20.4 J20.5 J20.6 J20.7 J20.8 J20.9 J40 J41.0 J41.1 J41.8 J42 J44.0 J44.1 J44.9 K11.7 K12.1 K12.2 K12.30 K12.39 K29.70 K29.71 K29.90 K29.91 K30 K52.21 K52.22 K52.29 K52.89 K70.41 K71.11 K72.01 K72.10 K72.11 K72.90 K72.91 K75.0 K75.1 K75.81 K76.0 K76.6 K76.7 K76.89 K80.30 K80.31 K80.32 K80.33 K80.34 K80.35 K80.36 K80.37 K80.50 K80.51 K81.0 K81.1 K81.2 K81.9 K83.0 K85.00 K85.01 K85.02 K85.10 K85.11 K85.12 K85.20 K85.21 K85.22 K85.30 K85.31 K85.32 K85.80 K85.81 K85.82 K85.90 K85.91 K85.92 K86.0 K86.1 K86.8 K86.81 K86.89 K87 L02.02 L02.03 L02.12 L02.13 L02.221 L02.222 L02.223 L02.224 L02.225 L02.226 L02.229 L02.231 L02.232 L02.233 L02.234 L02.235 L02.236 L02.239 L02.32 L02.33 L02.421 L02.422 L02.423 L02.424 L02.425 L02.426 L02.429 L02.431 L02.432 L02.433 L02.434 L02.435 L02.436 L02.439 L02.521 L02.522 L02.529 L02.531 L02.532 L02.539 L02.621 L02.622 L02.629 L02.631 L02.632 L02.639 L02.821 L02.828 L02.831 L02.838 L02.92 L02.93 L08.0 L08.81 L08.82 L08.89 L08.9 L29.0 L29.1 L29.2 L29.3 L68.0 L68.1 L68.2 L68.3 L68.8 L68.9 L74.4 L88 L89.000 L89.001 L89.002 L89.003 L89.004 L89.009 L89.010 L89.011 L89.012 L89.013 L89.014 L89.019 L89.020 L89.021 L89.022 L89.023 L89.024 L89.029 L89.100 L89.101 L89.102 L89.103 L89.104 L89.109 L89.110 L89.111 L89.112 L89.113 L89.114 L89.119 L89.120 L89.121 L89.122 L89.123 L89.124 L89.129 L89.130 L89.131 L89.132 L89.133 L89.134 L89.139 L89.140 L89.141 L89.142 L89.143 L89.144 L89.149 L89.150 L89.151 L89.152 L89.153 L89.154 L89.159 L89.200 L89.201 L89.202 L89.203 L89.204 L89.209 L89.210 L89.211 L89.212 L89.213 L89.214 L89.219 L89.220 L89.221 L89.222 L89.223 L89.224 L89.229 L89.300 L89.301 L89.302 L89.303 L89.304 L89.309 L89.310 L89.311 L89.312 L89.313 L89.314 L89.319 L89.320 L89.321 L89.322 L89.323 L89.324 L89.329 L89.40 L89.41 L89.42 L89.43 L89.44 L89.45 L89.500 L89.501 L89.502 L89.503 L89.504 L89.509 L89.510 L89.511 L89.512 L89.513 L89.514 L89.519 L89.520 L89.521 L89.522 L89.523 L89.524 L89.529 L89.600 L89.601 L89.602 L89.603 L89.604 L89.609 L89.610 L89.611 L89.612 L89.613 L89.614 L89.619 L89.620 L89.621 L89.622 L89.623 L89.624 L89.629 L89.810 L89.811 L89.812 L89.813 L89.814 L89.819 L89.890 L89.891 L89.892 L89.893 L89.894 L89.899 L89.90 L89.91 L89.92 L89.93 L89.94 L89.95 L92.1 L92.8 L94.2 L97.101 L97.102 L97.103 L97.104 L97.109 L97.111 L97.112 L97.113 L97.114 L97.119 L97.121 L97.122 L97.123 L97.124 L97.129 L97.201 L97.202 L97.203 L97.204 L97.209 L97.211 L97.212 L97.213 L97.214 L97.219 L97.221 L97.222 L97.223 L97.224 L97.229 L97.301 L97.302 L97.303 L97.304 L97.309 L97.311 L97.312 L97.313 L97.314 L97.319 L97.321 L97.322 L97.323 L97.324 L97.329 L97.401 L97.402 L97.403 L97.404 L97.409 L97.411 L97.412 L97.413 L97.414 L97.419 L97.421 L97.422 L97.423 L97.424 L97.429 L97.501 L97.502 L97.503 L97.504 L97.509 L97.511 L97.512 L97.513 L97.514 L97.519 L97.521 L97.522 L97.523 L97.524 L97.529 L97.801 L97.802 L97.803 L97.804 L97.809 L97.811 L97.812 L97.813 L97.814 L97.819 L97.821 L97.822 L97.823 L97.824 L97.829 L97.901 L97.902 L97.903 L97.904 L97.909 L97.911 L97.912 L97.913 L97.914 L97.919 L97.921 L97.922 L97.923 L97.924 L97.929 L98.0 L98.411 L98.412 L98.413 L98.414 L98.419 L98.421 L98.422 L98.423 L98.424 L98.429 L98.491 L98.492 L98.493 L98.494 L98.499 L98.8 M60.80 M60.811 M60.812 M60.819 M60.821 M60.822 M60.829 M60.831 M60.832 M60.839 M60.841 M60.842 M60.849 M60.851 M60.852 M60.859 M60.861 M60.862 M60.869 M60.871 M60.872 M60.879 M60.88 M60.89 M60.9 M79.1 M79.7 M86.071 M86.072 M86.079 M86.171 M86.172 M86.179 M86.271 M86.272 M86.279 M86.371 M86.372 M86.379 M86.471 M86.472 M86.479 M86.571 M86.572 M86.579 M86.671 M86.672 M86.679 M86.8X7 M86.9 N10 N11.0 N11.1 N11.8 N11.9 N12 N13.6 N15.1 N15.9 N16 N28.84 N28.85 N28.86 N30.90 N30.91 N31.2 N39.0 N44.1 N44.2 N44.8 N50.3 N50.811 N50.812 N50.819 N50.82 N50.89 N52.01 N52.02 N52.03 N52.1 N52.2 N52.31 N52.32 N52.33 N52.34 N52.39 N52.8 N52.9 N53.12 N53.8 N53.9 N76.0 N76.1 N76.2 N76.3 N91.0 N91.1 N91.2 N92.5 N92.6 N97.9 O09.00 O09.01 O09.02 O09.03 O09.10 O09.11 O09.12 O09.13 O09.211 O09.212 O09.213 O09.219 O09.291 O09.292 O09.293 O09.299 O09.30 O09.31 O09.32 O09.33 O09.40 O09.41 O09.42 O09.43 O09.511 O09.512 O09.513 O09.519 O09.521 O09.522 O09.523 O09.529 O09.611 O09.612 O09.613 O09.619 O09.621 O09.622 O09.623 O09.629 O09.70 O09.71 O09.72 O09.73 O09.811 O09.812 O09.813 O09.819 O09.821 O09.822 O09.823 O09.829 O09.891 O09.892 O09.893 O09.899 O09.90 O09.91 O09.92 O09.93 O24.011 O24.012 O24.013 O24.019 O24.03 O24.111 O24.112 O24.113 O24.119 O24.13 O24.311 O24.312 O24.313 O24.319 O24.33 O24.410 O24.414 O24.419 O24.430 O24.434 O24.439 O24.811 O24.812 O24.813 O24.819 O24.83 O24.911 O24.912 O24.913 O24.919 O24.93 O36.60X0 O36.60X1 O36.60X2 O36.60X3 O36.60X4 O36.60X5 O36.60X9 O36.61X0 O36.61X1 O36.61X2 O36.61X3 O36.61X4 O36.61X5 O36.61X9 O36.62X0 O36.62X1 O36.62X2 O36.62X3 O36.62X4 O36.62X5 O36.62X9 O36.63X0 O36.63X1 O36.63X2 O36.63X3 O36.63X4 O36.63X5 O36.63X9 O36.80X0 O36.80X1 O36.80X2 O36.80X3 O36.80X4 O36.80X5 O36.80X9 O40.1XX0 O40.1XX1 O40.1XX2 O40.1XX3 O40.1XX4 O40.1XX5 O40.1XX9 O40.2XX0 O40.2XX1 O40.2XX2 O40.2XX3 O40.2XX4 O40.2XX5 O40.2XX9 O40.3XX0 O40.3XX1 O40.3XX2 O40.3XX3 O40.3XX4 O40.3XX5 O40.3XX9 O40.9XX0 O40.9XX1 O40.9XX2 O40.9XX3 O40.9XX4 O40.9XX5 O40.9XX9 O99.810 O99.815 O99.840 O99.841 O99.842 O99.843 O99.844 O99.845 R00.0 R06.00 R06.09 R06.3 R06.4 R06.83 R06.89 R07.9 R15.0 R15.1 R15.2 R15.9 R16.0 R16.2 R19.7 R20.0 R20.1 R20.2 R20.3 R20.8 R20.9 R25.0 R25.1 R25.2 R25.3 R25.8 R25.9 R29.2 R35.0 R35.1 R35.8 R40.0 R40.1 R40.20 R40.2110 R40.2111 R40.2112 R40.2113 R40.2114 R40.2120 R40.2121 R40.2122 R40.2123 R40.2124 R40.2210 R40.2211 R40.2212 R40.2213 R40.2214 R40.2220 R40.2221 R40.2222 R40.2223 R40.2224 R40.2310 R40.2311 R40.2312 R40.2313 R40.2314 R40.2320 R40.2321 R40.2322 R40.2323 R40.2324 R40.2340 R40.2341 R40.2342 R40.2343 R40.2344 R40.4 R42 R45.2 R45.5 R45.6 R53.0 R53.1 R53.2 R53.81 R53.82 R53.83 R55 R56.00 R56.01 R56.1 R56.9 R61 R63.1 R63.2 R63.4 R63.5 R64 R68.2 R73.01 R73.02 R73.09 R73.9 R78.71 R78.79 R78.89 R79.0 R79.89 R79.9 R80.0 R80.1 R80.3 R80.8 R80.9 R81 Z08 Z09 Z79.02 Z79.1 Z79.3 Z79.4 Z79.51 Z79.52 Z79.891 Z79.899
Covered Diagnosis Code for Diabetic Screening Procedure Codes 82947, 82950, 82951
Z13.1
Non-Covered Diagnosis Codes
R99 Z00.00 Z00.01 Z00.110 Z00.111 Z00.121 Z00.129 Z00.5 Z00.6 Z00.70 Z00.71 Z00.8 Z02.0 Z02.1 Z02.2 Z02.3 Z02.4 Z02.5 Z02.6 Z02.71 Z02.79 Z02.81 Z02.82 Z02.83 Z02.89 Z02.9 Z04.6 Z04.8 Z04.9 Z11.0 Z11.1 Z11.2 Z11.3 Z11.4 Z11.51 Z11.59 Z11.6 Z11.8 Z11.9 Z12.0 Z12.10 Z12.13 Z12.2 Z12.6 Z12.71 Z12.72 Z12.73 Z12.79 Z12.81 Z12.82 Z12.83 Z12.89 Z12.9 Z13.0 Z13.21 Z13.220 Z13.228 Z13.29 Z13.4 Z13.5 Z13.71 Z13.79 Z13.810 Z13.811 Z13.818 Z13.820 Z13.828 Z13.83 Z13.84 Z13.850 Z13.858 Z13.88 Z13.89 Z13.9 Z36 Z40.00 Z40.01 Z40.02 Z40.09 Z40.8 Z40.9 Z41.1 Z41.2 Z41.3 Z41.8 Z41.9 Z46.1 Z56.0 Z56.2 Z56.3 Z56.4 Z56.5 Z56.6 Z56.81 Z56.82 Z56.89 Z56.9 Z57.0 Z57.1 Z57.2 Z57.31 Z57.39 Z57.4 Z57.5 Z57.6 Z57.7 Z57.8 Z57.9 Z59.0 Z59.1 Z59.2 Z59.3 Z59.4 Z59.5 Z59.6 Z59.7 Z59.8 Z59.9 Z60.2 Z62.21 Z71.0 Z74.1 Z74.2 Z74.3 Z74.8 Z74.9 Z75.5 Z76.0 Z76.1 Z76.2 Z76.3 Z76.4 Z76.81 Z80.1 Z80.2 Z80.49 Z80.51 Z80.52 Z80.59 Z80.6 Z80.7 Z80.8 Z80.9 Z81.0 Z81.1 Z81.2 Z81.3 Z81.4 Z81.8 Z82.0 Z82.1 Z82.2 Z82.3 Z82.41 Z82.49 Z82.5 Z82.61 Z82.62 Z82.69 Z82.71 Z82.79 Z82.8 Z83.0 Z83.1 Z83.2 Z83.3 Z83.41 Z83.49 Z83.511 Z83.518 Z83.52 Z83.6 Z83.71 Z83.79 Z84.0 Z84.1 Z84.2 Z84.3 Z84.89
| The policy position applies to all Medicare Advantage lines of business |
| Denial Statements |
A network provider can bill the member for the non-covered service.
Services denied as not reasonable and medically necessary, under section 1862(a)(1) of the Social Security Act, are subject to the Limitation of Liability provision. A contracted provider must inform the enrollee to request an organization determination from the plan or the provider can request the organization determination on the enrollee’s behalf. Failure to provide a compliant denial to the enrollee means that the enrollee is not liable for services provided by a contracted provider or upon referral from a contracted provider.
| Links |
