# 410.18 Diabetes screening tests.
(a) *Definitions.* For purposes of this section, the following definitions apply:
*Diabetes* means diabetes mellitus, a condition of abnormal glucose metabolism.
(b) *General conditions of coverage.* Medicare Part B covers diabetes screening tests after a referral from a physician or qualified nonphysician practitioner to an individual at risk for diabetes for the purpose of early detection of diabetes.
(c) *Types of tests covered.* The following tests are covered if all other conditions of this subpart are met:
(1) Fasting blood glucose test.
(2) Post-glucose challenges including, but not limited to, an oral glucose tolerance test with a glucose challenge of 75 grams of glucose for non-pregnant adults, a 2-hour post glucose challenge test alone.
(3) Hemoglobin A1C test.
(4) Other tests as determined by the Secretary through a national coverage determination.
(d) *Amount of testing covered.* Medicare covers two tests within the 12-month period following the date of the most recent diabetes screening test of that individual.
(e) *Eligible risk factors.* Individuals with the following risk factors are eligible to receive the benefit:
(1) Hypertension.
(2) Dyslipidemia.
(3) Obesity, defined as a body mass index greater than or equal to 30 kg/m
<sup>2</sup>.
(4) Prior identification of impaired fasting glucose or glucose intolerance.
(5) Any two of the following characteristics:
(i) Overweight, defined as body mass index greater than 25, but less than 30 kg/m
<sup>2</sup>.
(ii) A family history of diabetes.
(iii) 65 years of age or older.
(iv) A history of gestational diabetes mellitus or delivery of a baby weighing more than 9 pounds.
[69 FR 66421, Nov. 15, 2004, as amended at 88 FR 79525, Nov. 16, 2023]