What is the CPT Code for Hgb A1c?

Monitoring blood sugar levels is essential for managing diabetes, and one of the most common tests used is the Hemoglobin A1c (Hgb A1c) test. This test measures the average blood glucose levels over the past two to three months, providing critical information for both diagnosis and long-term diabetes management.

Accurate coding for this test is crucial for smooth billing, insurance claims, and proper reimbursement. Let’s explore the CPT code for Hgb A1c and why it matters.

The CPT Code for Hgb A1c

The standard CPT code for Hemoglobin A1c is 83036. This code applies when a healthcare provider performs a quantitative measurement of glycosylated hemoglobin using laboratory methods such as HPLC.

There is also CPT code 83037, used for Hgb A1c testing performed with FDA-cleared devices for home or office use.

• 83036 – Hemoglobin; glycosylated (A1c) by HPLC or other laboratory methods
• 83037 – Hemoglobin; glycosylated (A1c) by FDA-cleared home/office devices

Using the correct CPT code ensures that claims are processed correctly and that healthcare providers receive timely reimbursement.

Why Correct CPT Coding is Important

Incorrect CPT coding can lead to:

• Claim denials
• Delayed reimbursement
• Compliance issues during audits

Partnering with a reliable medical billing company ensures accurate coding, proper documentation, and faster claim processing. At EZsettle Solutions, our team specializes in accurate CPT code assignment and revenue cycle management, helping healthcare providers maximize reimbursements.

Coverage and Billing Guidelines

Medicare and most private insurers cover Hgb A1c testing when medically necessary. For patients with diabetes:

• Stable patients: testing recommended twice per year
• Changing therapy or uncontrolled glucose: testing may be done up to four times per year

For additional guidelines on lab testing and diabetes management, refer to the American Diabetes Association for authoritative recommendations. ✅ (external link)

How EZsettle Solutions Supports Practices

Billing for lab tests like Hgb A1c requires more than just knowing the CPT code—it involves proper documentation, correct modifiers, and adherence to payer-specific rules. Our experts at EZsettle Solutions simplify this process so healthcare providers can focus on patient care.

Explore more about our services and coding expertise:

• CPT Code for BMP (Basic Metabolic Panel) – Another key lab test coding guide.
• What is the CPT Code for an Abdominal Ultrasound? – Learn how similar lab and imaging codes are handled.
• Revenue Cycle Management in Medical Billing – Understand the end-to-end process for optimized reimbursement.

FAQ

1. How often should Hgb A1c be billed?

• Typically twice a year for stable diabetes patients, and up to four times per year if therapy changes.

2. Is CPT 83036 covered by Medicare?

• Yes, when medically necessary and documented correctly.

3. What is the difference between 83036 and 83037?

• 83036: Standard lab-based test
• 83037: FDA-cleared point-of-care device test

4. Can EZsettle Solutions help with Hgb A1c billing?

• Absolutely. Our team ensures accurate CPT code usage, compliance, and maximized reimbursement.

Conclusion

The CPT code for Hgb A1c is 83036, with 83037 for home/office device testing. Accurate coding is essential to avoid claim denials and ensure timely reimbursement.

With EZsettle Solutions, healthcare providers can streamline billing, manage CPT codes accurately, and optimize revenue while focusing on patient care.