I’ve heard appending modifier TS for diabetes screening codes is optional for pre-diabetes. Is this true?


No, it is not optional. You must append modifier TS to the CPT® code when submitting claims for the screening of Medicare beneficiaries diagnosed with pre-diabetes (previous fasting glucose level of 100–125 mg/d or a two-hour post-glucose challenge of 140–199 mg/dL). This modifier communicates to the intermediary, A/B MAC or carrier that the allowed frequency of each six months applies to the claim. Medicare beneficiaries diagnosed with pre-diabetes will be eligible for the maximum frequency allowed by the statute, which is two screening tests per 12-month period.

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