covered DX for CPT 83036 - 211.7,250.00 V58.69

83036 - Hemoglobin; glycosylated

CPT code 83036, glycosylated (A1c), already existed and was priced at $13.56 on the clinical laboratory fee schedule. 

• For tests furnished on or after April 1, 2008, the payment for 83037 or 83037QW will be the same as the payment on the clinical laboratory fee schedule for 83036.

CPT code 83036 require CLIA certificate and use QW modifier

 CPT code 83037 became available in 2006 and most insurers utilize this new code. Other insurers continue to use CPT code 83036. Check with local insurers to confirm the appropriate CPT billing code.

UnitedHealthcare Community Plan reimburses for Glycated Hemoglobin/Glycated Protein Testing (CPT codes 82985 and 83036), when the claim indicates a code found on the list of approved diagnosis codes for this test


Acceptable POS code


11 - Hospital Inpatient (Including Medicare Part A)
12 - Hospital Inpatient (Medicare Part B only)
13 - Hospital Outpatient
14 - Hospital - Laboratory Services Provided to Non-patients
18 - Hospital - Swing Beds
21 - Skilled Nursing - Inpatient (Including Medicare Part A)
22 - Skilled Nursing - Inpatient (Medicare Part B only)

23 - Skilled Nursing - Outpatient
71 - Clinic - Rural Health
85 - Critical Access Hospital



Most used ICD 10 code

GLYCOSYLATED HEMOGLOBIN (CPT 83036, 83037)

ICD-10 Description ICD-10 ICD-9

Abnormal Finding Of Blood Chemistry, Unspecified R79.9 790.6
Other Abnormal Glucose R73.09 790.29

Other Long-Term (Current) Drug Therapy Z79.899 V58.69



Billing and Coding Guidelines



The CPT code, effective date and description for the latest tests approved by the FDA as waived tests under CLIA are the following:


• 83036QW, August 10, 2015, PTS Diagnostics A1C + Professional Use;

• 82274QW, G0328QW, September 14, 2015, Tanner Scientific iFOB One Step Rapid Test;

• 87502QW, September 18, 2015, Roche Molecular, cobas Liat System (cobas Liat Influenza A/B Assay; 



CPT Codes: 83036, 83037, 3044F, 3045F, 3046F



Diabetes Hemoglobin A1c Testing

Claims including procedure code 83036 or 83037 should include a line item with the resulting CPT procedure code below and be billed with a zero charge. 


CPT

83036, 83037 80061, 83700, 83701, 83704, 83721 67028, 67030, 67031, 67036, 67039-67043, 67101, 67105, 67107, 


Entering Numerator Data

To report on this measure, you must order or perform an A1c test using CPT code 83036 or 83037 and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved. 


The A1c test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the HGB A1c value. Results stored in the database as text notes or image file cannot be used for PQRS reporting. 


You must associate a LOINC code to the A1C test item on each lab template for both manually entered and electronic results. LOINC codes for this result are 17856-6, 4549-2, or 4548-4.


Diagnosis (ICD-9) Codes

An appropriate diagnosis (ICD-9) code (or narrative description) must be indicated for each service or supply billed under Medicare Part B. ICD-9-CM is an acronym for International Classification of Diseases, 9th Revision, Clinical Modification.

When a patient presents with an undiagnosed illness, the ICD-9 code is determined by the "signs and symptoms" present. Symptoms are defined as what the patient tells the  physician. Signs are what the physician observes as part of his examination of the patient.

Definitive ICD-9 codes should only be assigned and recorded in the medical record after a diagnosis is clearly determined. Terms such as "rule out", "probable", and "suspected" should NOT be used since they can not be coded as such and may be interpreted as a firm diagnosis by a third party payer.


ICD-9 Codes Covered by Medicare

211.7 Benign neoplasm of islets of Langerhans
250.00-250.93 Diabetes mellitus and related codes
251.0 Hypoglycemic coma
251.1 Other specified hypoglycemia
251.2 Hypoglycemia, unspecified
251.3 Post-surgical hypoinsulinemia
251.4 Abnormal secretion of glucagon
251.8 Other specified disorders of pancreatic internal secretion
251.9 Unspecified disorder of pancreatic internal secretion
258.0-258.9 Polyglandular dysfunction and related disorders
271.4 Renal glycosuria
275.0 Disorders of iron metabolism (hemachromatosis)
577.1 Chronic pancreatitis
579.3 Other and unspecified post-surgical nonabsorption
648.00 Diabetes mellitus complicating pregnancy, unspecified episode
648.03 Diabetes mellitus complicating pregnancy, antipartum complication
648.04 Diabetes mellitus complicating pregnancy, postpartum complication
648.80 Abnormal glucose tolerance complicating pregnancy, unspecified episode
648.83 Abnormal glucose tolerance complicating pregnancy, antipartum complication
648.84 Abnormal glucose tolerance complicating pregnancy, postpartum complication
790.2 Abnormal glucose tolerance test
790.6 Other abnormal blood chemistry (hyperglycemia)
962.3 Poisoning by insulin and antidiabetic agents
V12.2 Personal history of endocrine, metabolic, and immunity disorders
V58.69 Long term current use of other medication

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