Laboratory Question for the Week of March 30, 2020

Laboratory Compliance Question of the Week


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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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.