Diabetes Awareness
According to the Centers for Medicare & Medicaid Services (CMS), diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18–79) by 2050 if current trends continue.
CDC’s Diabetes Report Card states total medical costs and lost work and wages for people with diagnosed diabetes is $413 billion. Medical costs for people with diabetes are more than twice as high as for people without diabetes.
Diabetes Overview
The U.S. Centers for Disease Control and Prevention (CDC) tells us diabetes is a group of diseases characterized by high blood sugar. When a person has diabetes, the body either does not make enough insulin (type 1) or is unable to properly use insulin (type 2). When the body does not have enough insulin or cannot use it properly, blood sugar (glucose) builds up in the blood. Prediabetes is a condition in which blood sugar is higher than normal but not high enough to be classified as diabetes.
People with diabetes can develop high blood pressure, high cholesterol, and high triglycerides (a type of fat in the blood). High blood sugar, particularly when combined with high blood pressure and high triglycerides or too much LDL ('bad') cholesterol levels, can lead to heart disease, stroke, blindness, kidney failure, amputations of the legs and feet and even early death.
Diabetes is also associated with increased risk of certain types of cancer, such as liver, pancreas, uterine, colon, breast and bladder cancer. High blood sugar also increases the chance of developing dementia and Alzheimer’s disease. In addition, the average medical costs for people with diagnosed diabetes are 2.3 times higher than costs for people without diabetes. These higher costs are often caused by diabetes-related health conditions and resulting hospitalizations.
People with diabetes, their caregivers and health care providers, departments of health, policy makers, and community organizations can all help to reduce the risk of serious diabetes-related complications. There is not a cure yet for diabetes, but we know losing weight, eating healthy food, and being active can really help.
What Does the Research Show?
- Blood pressure management can reduce the risk of heart disease and stroke by 12 percent to 27 percent and the risk of progression of kidney disease by 30 percent to 70 percent
- Cholesterol management can reduce cardiovascular complications by 20 percent to 50 percent
- Regular eye exams and timely treatment could prevent up to 90 percent of diabetes-related blindness
- Regular foot exams and patient education of proper foot care could prevent up to 85 percent of diabetes-related amputations
Did You Know?
- Approximately 38.4 million Americans have diabetes
- 8.7 million Americans, or about one in five people, are unaware that they have diabetes
- Approximately 97.6 million people ages 18 or older have prediabetes, a condition in which blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes
- 26.4 million people aged 65 years or older have prediabetes (38 percent of the adult U.S. population)
- More than eight in 10 adults living with prediabetes are unaware they have prediabetes
- About half of women with gestational diabetes go on to develop type 2 diabetes. Gestational diabetes is a type of diabetes that women develop when they are pregnant.
- Diabetes is the eighth leading cause of death in the U.S.
- Diabetes is the number one cause of kidney failure, lower-limb amputations, and adult blindness
- In the last 20 years, the number of adults diagnosed with diabetes has more than doubled
What Can a Provider Do?
Providers should encourage beneficiaries to manage their blood glucose, blood pressure and cholesterol levels. Research shows that managing diabetes as soon as possible after diagnosis may help prevent diabetes health problems. Start by managing the ABCs of diabetes.
A is for the A1C used to measure average blood glucose levels.
B is for blood pressure.
C is for cholesterol.
Educate your beneficiaries what their ABCs goals should be.
- Encourage your beneficiaries to take the Diabetes Risk Test online
- Educate Managing Diabetes
- Educate on Risk Factors for Type 2 Diabetes
- Educate and encourage your patients to adopt healthy lifestyle habits such as planning healthy meals, being physically active, getting enough sleep, and not smoking. Awareness of help such as dieticians and personal trainers may help
- Remind timely medications is important as well as taking medicine even when feeling well. Encourage patients to ask for education about medications from their pharmacist.
- Examine your patients’ feet. Educate on the importance of safe and proper foot care.
- Discuss the value of maintaining a healthy weight. Encourage healthy eating, physical activity, and possible other weight-loss treatments.
- Consider patients mental health. Diabetes, like all chronic illnesses, can leave patients feeing down, sad and overwhelmed. Consider referrals to mental health counselors or support groups to learn healthy ways to cope.
- Diabetes can be expensive. Medications, devices, and frequent appointments can feel like an insurmountable obstacle for some patients A social worker may be able to find community resources or financial help for diabetes care.
- Build a diabetes team. Know what resources are available for your patients. A diabetic health care team may include the primary care physician, diabetes specialist, registered dietician and/or a certified diabetes educator.
There are resources and information for Diabetes Professionals at CDC.gov.
Diabetes Screening
What’s Changed? No changes from the last quarter.
HCPCS & CPT© Codes
- 82947 — Glucose; quantitative, blood (except reagent strip)
- 82950 — Glucose; post glucose dose (includes glucose)
- 82951 — Glucose; tolerance test (GTT), three specimens (includes glucose)
ICD-10 Codes — Z13.1
Additional ICD-10 codes may apply. Find individual change requests and specific ICD-10-CM service codes we cover on the CMS ICD-10 web page. See PalmettoGBA.com for more information.
Medicare Covers
Patients with Medicare Part B with certain diabetes risk factors or who have been diagnosed with pre-diabetes. Patients previously diagnosed with diabetes are not eligible for this benefit.
Frequency
- One screening every six months for patients diagnosed with pre-diabetes
- One screening every 12 months for patients previously tested but not diagnosed with pre-diabetes or patients who were never tested
See FAQ on Medicare Preventive Services.
Patient Pays
No copayment, coinsurance, or deductible.
Other Notes
- Add modifier TS (follow-up service) when patients meet the pre-diabetes definition
- We pay ordering providers’ and suppliers’ DME claims when they’re actively enrolled in Medicare on the service date or if the provider has a valid opt-out affidavit on file. If you don’t participate in Medicare, tell your patients before you order DME.
CPT® only copyright 2023 American Medical Association. All rights reserved.
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