Laboratory Question for the Week of October 31, 2022

Question:

Do we need a modifier for submitting claims for the screening of Medicare beneficiaries diagnosed with pre-diabetes?

Answer:

You must append modifier TS to the CPT code when submitting claims for 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.

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