Professionals - A1CNow^+® Reimbursement Information

Centers for Medicare and Medicaid Services (CMS) General Reimbursement Information

CMS is the government agency that is responsible for the Medicare and Medicaid programs.

CMS Reimbursement:[1]

• A1C testing using Bayer's A1CNow^+® is reimbursed by Medicare using CPT code 83037.
• Medicaid is a state-administered program, and each state sets it's own guidelines regarding eligibility and services.  As a result, Medicaid reimbursement for HbA1C testing varies by state.
• Outpatient clinical laboratory services are paid based on a fee schedule in accordance with Section 1833(h) of the Social Security Act. Payment is the lesser of the amount billed, the local fee for a geographic area, or a national limit.
• In accordance with the statute, the national limits are set at a percent of the median of all local fee schedule amounts for each laboratory test code. Each year, fees are updated for inflation based on the percentage change in the Consumer Price Index. However, legislation by the Congress can modify the update to the fees.
• Co-payments and deductibles do not apply to services paid under the Medicare or Medicaid clinical laboratory fee schedule.

CMS Claims and Denials:

• When insurers deny claims, they usually list the reason on the denied claim.
• Incorrect coding, lack of a QW modifier (for Medicare and Medicaid), and missing clinical information are often the reasons for the claim rejection. In such cases, please correct and resubmit the claim.
• Insurers may also request that the provider document the medical necessity of the A1C test. In this case, the provider may need to submit a letter of medical necessity.

Contact Us

For assistance with reimbursement questions, contact the A1CNow+® Reimbursement Program at (866) 999-1415.
 

DISCLAIMER: The above reimbursement information is provided for A1CNow+ customers from publicly available sources. Private insurance reimbursement information is not included. Customers should check with local insurers to verify the information because it may vary or change from insurer to insurer. Bayer HealthCare does not guarantee that any of the information above will result in coverage or payment.

Resources

CLIA Certificate of Waiver: http://www.cms.hhs.gov/CLIA/01_Overview.asp#TopOfPage
Medicare Coverage Center: http://www.cms.hhs.gov/mcd/overview.asp
Clinical Laboratory Fee Schedule for 2011: http://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/11clab.zip