---
kind: "section"
citation: "42 C.F.R. § 410.18"
title: "42"
number: "410.18"
heading: "Diabetes screening tests."
url: "https://uscodex.org/cfr/42/410.18"
---

# §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 2.**
  - (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 2.**
    - (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.**

## Notes

### Amendments

[69 FR 66421, Nov. 15, 2004, as amended at 88 FR 79525, Nov. 16, 2023]

### Authority

Authority: 42 U.S.C. 1302, 1395m, 1395hh, 1395rr, and 1395ddd.

### Source

Source: 51 FR 41339, Nov. 14, 1986, unless otherwise noted.

### Amendments

[69 FR 66421, Nov. 15, 2004, as amended at 88 FR 79525, Nov. 16, 2023]