Two basic criteria must be met for Medicare to provide testing and diagnostic services for CPT 83036. Tests and diagnostic services are covered by Medicare for certain procedures, such as routine exams, but are not covered until they are medically necessary or indicated.
Medicares payments for clinical laboratory tests are usually less than the fee plan amount and the actual invoice amount. Airlines publish unique laboratory fee plans and on 1 January change the payment levels annually based on congressional budget recommendations.
These tests are billed to Medicare by the lab or doctor who performed the test. Medicare patients will not be charged an additional amount. Any provider that accepts Medicare reimbursement for paying for a full lab test (i.e. An outside lab that performs tests without a referral from a physician or reference laboratory) can charge Medicare for a test.
CPT 83036 Definition
The CPT codes for Glycated Hemogobin (A1c) determinations are:
CPT 83036: Hemoglobin; glycated (A1c)
CPT 83036QW: Hemoglobin; glycated (A1c) using CLIA waived method.
Note: Most insurers use CPT 83037 that became available in 2006. Check with the local insurer.
CPT 83036 and CPT 83036QW Reimbursement
$13.42 in all states except Oklahoma ($11.95), Idaho ($9.66), South Dakota ($12.86), Maryland ($12.66), Rhode Island ($12.09) & Wyoming: ($10.49).
CPT 83036 Modifier
CPT 83036 requieres a CLIA certificate and the QW modifier can be used.
CPT 83036 POS Codes
POS Code 11: Hospital Inpatient (Including Medicare Part A).
POS Code 12: Hospital Inpatient (Medicare Part B only).
POS Code 13: Hospital Outpatient.
POS Code 14: Hospital – Laboratory Services Provided to Non-patients.
POS Code 18: Hospital – Swing Beds.
POS Code 21: Skilled Nursing – Inpatient (Including Medicare Part A).
POS Code 22: Skilled Nursing – Inpatient (Medicare Part B only.
POS Code 23: Skilled Nursing – Outpatient 71 – Clinic – Rural Health 85 – Critical Access Hospital.