A1C CPT Code

A1C CPT Code 83037 (2022) Description, Guidelines, Reimbursement, Modifiers & Example

A1C CPT code 83037 (hemoglobin, glycosylated) via home use device may create to document an A1C test performed at the patient’s home with FDA-cleared equipment. The A1C test, also defined as the hemoglobin A1C or HbA1c test, identifies the glucose level in the blood. You and your medical team will use it as a primary tool for managing your diabetes and among the most common tests for detecting diabetes complications.

Summary

A1C CPT code 83037 cannot use to report a patient- or family-conducted glycosylated hemoglobin (A1C) test. Code 83037 may use to record testing results on continuous interaction with FDA-approved home-use devices to aid a physician with a diabetic patient’s glucose control while the practitioner is present. 

A diagnostic medical test that may perform by the patient or their family will not cover by Medicare. Clinical laboratories must adhere to all applicable Medicare requirements without exception. 

We’re also concerned that the proliferation of identical Metrika tests may lead to a messy claim coding system in the coming years. A1C CPT code 83037 has been the subject of great confusion since the February 2006 and October 2006 CPT® Assistants. 

This NCD’s HCPCS table has a code, A1C CPT code 83037, that we believe could lead to erroneous Medicare claims for services not covered by the program. Diagnosing diabetes or pre-diabetes in adults can be done with the help of an HbA1c test. With pre-diabetes, your blood sugar levels show an increased risk for diabetes. 

Diabetes patients can use an HbA1c test to keep track of their glucose and insulin levels. It’s a relatively low-risk procedure to have a blood test done. In most cases, the effects of the injection fade within a day or two, if not sooner. 

The results of the HbA1c test do present as a percent. Examples of typical outcomes include the following:

  • Normal HbA1c levels are between 5.7 and 6.4%.
  • Pre-diabetes may diagnose when HbA1c levels range from 5.7 to 6.4 %.
  • Diabetes may diagnose when the HbA1c level is more significant than 6.5 %.

Because of this, we will not use the CAL procedure to add this code to the NCD list, as we do not believe it is necessary. When the NCD may reevaluate, we believe that the facts pertinent to adding CPT code 83037 will take into account appropriately.

cpt code for hemoglobin a1c

A1C CPT Code Description

Hemoglobin A1c (HbA1c) testing is recommended by the American Diabetes Association twice a year for persons with stable glycemia and once a quarter for those with poor glucose control to aid in blood glucose management. Interpretive ranges may base on the ADA guidelines.

A worldwide expert committee’s suggestion in 2010 to use the A1c test to diagnose diabetes with a 6.5 percent threshold will affirm by the American Diabetes Association in 2012. Point-of-care Diagnostic use of A1c tests is not possible due to their lack of precision.

Routine checkups, for example, are not covered by Medicare until they are deemed medically necessary or indicated. As sugar enters your bloodstream, it adheres to hemoglobin, a protein present in red blood cells. 

Everyone’s sugar may link to their hemoglobin, but those with greater blood glucose levels have a more significant. The A1C test can determine sugar-coated hemoglobin within your red blood cells

Medicare frequently pays less than the fee schedule and the actual invoice amount for clinical laboratory testing. Airlines set their laboratory fees, which may revise on January 1 of each year following budget recommendations made by Congress.

A comprehensive lab test can be billed to Medicare by any provider who accepts Medicare reimbursement (e.g., an outside lab performing tests without a physician’s or reference laboratory’s recommendation). The lab or doctor who performed these tests may bill Medicare. Patients on Medicare will not have to pay additional fees.

However, it can take two or three days to receive these results; rapid glycated hemoglobin (HbA1c or A1c) measuring equipment, sometimes referred to as the point of care devices, can measure HbA1c (or A1c). A Digital A1c reading may provide five minutes after a finger prick of blood.

Fasting laboratory testing and self-monitoring blood glucose findings are critical in managing diabetes patients. Glucose levels can also monitor using glycated hemoglobin (HbA1c). According to the American Diabetes Association, HbA1c should be tested at least twice a year (ADA, 2009). There is a direct correlation between the HgA1c test and blood glucose levels over two or three months.

A1C CPT Code Billing Guidelines

A1C CPT code 83037 may use to code for pathology and laboratory/chemical services. According to standard practice, this code will use to report a patient’s hemoglobin A1c level. The costs associated with this treatment may base on publicly accessible data listing all providers that billed Medicare for this code. 

The QW modifier is used for billing to measure the level of glucose. A1C CPT code 83037 Glycosylated hemoglobin (A1c) has been cleared for use at home by the FDA. You can bill the E&M code 99211 for an HbA1c test performed by a nurse or other non-physician health care worker when the nurse takes vital signs, compares the results to preset guidelines, and gives the patient advice based on that information.

Because it includes the evaluation and management services provided to a patient during an office visit, the interpretation of test findings is not chargeable separately. E & M services for current patients are under 99212 – 99215.

 There must be a definitive medical (ICD-9-CM) code (or narrative description) in the patient’s medical record for each treatment or supply invoiced under Medicare Part B. An ICD-9-CM code is assigned to patients based on their “signs and symptoms” when they present with an ailment. 

The FDA has approved an A1CNow+ CLIA waiver test. CLIA certification is required for clinical laboratory tests, while just a CLIA Certificate of Waiver may need waived category testing. 

Labs with a Certificate of Waiver may require registering with Medicare, paying a fee every two years, and agreeing to perform clinical laboratory tests following the manufacturer’s recommendations.

Modifiers

An A1c test may perform in a doctor’s office using FDA-approved home use equipment with a bill using CPT code 83037. An A1c test result obtained by the patient or a member of the patient’s family at home will report using A1C CPT code 83037. The QW modifier will use when coding for Medicare and Medicaid users.

A CLIA1 Certificate of Waiver has been given to the test and laboratory, as indicated by the QW modifier (83037QW). Get the CPT billing code from your insurance company. If the evaluation and management services are provided and documented in the patient’s medical records, providers can bill for the services.

CLIA application form (CMS-116) can be downloaded from www.cms.hhs.gov/clia, followed by mailing it to the appropriate state agency. At www.cms.hhs.gov/clia, you can get a list of state agency addresses.

Under the Clinical Laboratory Improvement Amendment, the QW modifier is exempt from testing (CLIA). Keep these things in mind while adding the QW modifier to your lab services: The modifier may supply the first modifier field to identify tests that may waive.

  • The CPT/HCPCS code 83037QW will allocate to the following previously listed tests, with an Effective Date of January 1, 2006:
  • Bio-Rad Micromat II; • Cholestech GDX A1C Test (Prescription Home Use; Cholestech GDX A1C Test; Cholestech GDX A1C Test
  • Metrika A1c can now be prescribed for usage at home by patients (K020234).

There are two types of GlycosalTM HbA1c tests available: one from Provalis Diagnostics and the other from In2it In-Office Analyzer by Provalis Diagnostics (II).

Any test with a high level of complexity is exempt from inclusion in the Clinical Laboratory Improvement Amendments database. The database indicates which testing systems manufacturers may be exempt from CLIA rules. A QW adjustment to the HCPCS code includes in the submission.

The modifier used for A1C CPT code is QW

A1C CPT Code Reimbursement

When an insurance claim denies, a letter detailing the denial may typically send to the claimant. Incorrect codes, the absence of a QW modifier (for Medicare and Medicaid), and omitted information frequently lead to claim rejection. Correct the claim and submit it again if necessary. Insurers may require medical documentation proving the necessity of an HbA1c test.

Examples

The following examples are when A1C CPT code 83037 may be used.

Example 1

The newborn is only new to you if no one else in your group practices seeing them in person before you. The definition of new patient service in specific plans does not include subspecialties. As a family physician with a specialty (such as a hospitalist), your team should review your health plan’s reimbursement regulations to see if the CPT standard or their definition of a new patient may use.

Example 2

Due to incident-to requirements, new patient visits cannot be billed as split or shared E/M services in the office setting. Suppose a nurse practitioner (or other qualified health care professional who can report E/M services) offers a portion of the E/M service for a new patient.

Example 3

As recommended by the CDC, everyone over 45 should have their blood sugars tested for signs of diabetes and pre-diabetes (CDC). Every 1-2 years may recommend an interval for blood sugar checks if you have pre-diabetes.

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