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Percent of Diabetic Medicare Beneficiaries Age 65-75 Receiving Three Recommended Tests
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    Region
    (Click a region name
    below to view its profile)
    Percent of Diabetic Medicare Beneficiaries Age 65-75 Receiving Three Recommended Tests
    (Year: 2012; Region Levels: State)
    Alabama 49.9%
    Alaska 38.4%
    Arizona 49.7%
    Arkansas 49.3%
    California 49.6%
    Colorado 48.0%
    Connecticut 60.1%
    Delaware 60.9%
    District of Columbia 52.2%
    Florida 58.0%
    Georgia 50.7%
    Hawaii 61.8%
    Idaho 45.4%
    Illinois 52.1%
    Indiana 45.2%
    Iowa 60.8%
    Kansas 54.4%
    Kentucky 49.4%
    Louisiana 47.2%
    Maine 64.1%
    Maryland 55.1%
    Massachusetts 65.6%
    Michigan 51.8%
    Minnesota 60.3%
    Mississippi 46.3%
    Missouri 53.1%
    Montana 48.3%
    Nebraska 53.4%
    Nevada 46.8%
    New Hampshire 63.5%
    New Jersey 55.3%
    New Mexico 41.2%
    New York 58.3%
    North Carolina 57.7%
    North Dakota 59.5%
    Ohio 50.0%
    Oklahoma 45.5%
    Oregon 53.6%
    Pennsylvania 56.1%
    Rhode Island 60.6%
    South Carolina 53.9%
    South Dakota 53.1%
    Tennessee 51.5%
    Texas 51.3%
    Utah 48.7%
    Vermont 55.4%
    Virginia 56.9%
    Washington 53.6%
    West Virginia 47.2%
    Wisconsin 59.3%
    Wyoming 38.2%
    National Average 53.2%
    90th Percentile 60.9%
    50th Percentile 53.1%
    10th Percentile 46.3%
        • DENOMINATOR DEFINITION:
        • Non-HMO Medicare enrollees age 65 - 75 (on December 31) with Parts A & B eligibility, 20% sample with diagnosis of diabetes.

          Diabetes diagnosis: two face-to-face encounters with different dates of service in an ambulatory setting or nonacute inpatient setting or one face-to-face encounter in an acute inpatient or emergency room setting during measurement year or prior year.

          Diabetes definition: ICD-9 codes: 250xx, 357.2x, 362.0x, 366.41, 648.0x: DRGs 294, 295; for Q4, MS-DRG codes 637, 638, 639.

          Outpatient/non-acute inpatient CPT codes: 92002-92014, 99201-99205, 99211-99215, 99217-99220, 99241-99245, 99341-99345, 99347-99350, 99384-99387, 99394-99397, 99401-99404, 99411-99412, 99420, 99429, 99455, 99456, 99499, 99301-99313, 99315, 99316, 99318, 99321-99328, 99331-99337.

          Acute inpatient/emergency department CPT codes: 99221-99223, 99231-99233, 99238, 99239, 99251-99255, 99261-99263, 99291, 99281-99285.

          Outpatient/non-acute inpatient revenue center codes: 051x, 052x, 057x-059x, 077x, 082x-085x, 088x, 0982, 0983, 0118, 0128, 0138, 0148, 0158, 019x, 055x, 066x.

          Acute inpatient/emergency department revenue center codes: 010x, 0110-0114, 0119, 0120-0124, 0129, 0130-0134, 0139, 0140-0144, 0149, 0150-0154, 0159, 016x, 020x-022x, 072x, 080x, 0987, 045x, 0981.

        • NUMERATOR DEFINITION:
        • Hemoglobin A1c testing: CPT codes 83036, 83037; CPT II codes 3046F, 3047F.

          Blood lipids testing: CPT codes 80061, 83700, 83701, 83704, 83715, 83716, 83721; CPT II codes 3048F, 3049F, 3050F.

          Eye examination: a retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year*; or a negative retinal exam (no evidence of retinopathy: ICD-9 codes 250.50-250.53, 362.01-362.07) by an eye care professional in the year prior to the measurement year (specialty codes: 18=ophthalmology, 41=optometry).

          *ICD-9 procedure codes 14.1-14.59, 14.9, 95.02-95.04, 95.11, 95.12, 95.16; CPT codes 67028, 67038-67040, 67101, 67105, 67107, 67108, 67110, 67112, 67141, 67145, 67208, 67210, 67218, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92225, 92226, 92230, 92235, 92240, 92250, 92260, 99203-99205, 99213-99215, 99242-99245; CPT II codes 2022F, 2024F, 2026F, 3072F; HCPCS codes S0625, S3000.




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