Professionals - A1CNow+® Reimbursement Information
ICD9 codes (International Classification of Diseases):
- Definition: The ICD9 coding system is an international classification system which groups related disease entities and procedures for the purpose of reporting.
- An appropriate diagnosis (ICD-9-CM) code must be identified in the patient’s medical record and reported on the claim form to the patient’s insurer, for each service or supply billed under Medicare Part B. When a patient presents with an illness, the provider selects the ICD-9-CM code or codes by the "signs and symptoms" that most accurately describe the patient’s condition.
Evaluation and Management Guidelines:
- Clinicians/providers determine the appropriate E&M codes for the services rendered to the patient during the office visit
- Bayer cannot provide guidance and/or interpretation on E&M codes
- For further information on payment for E&M codes, please visit:
CPT code (Current Procedural Terminology):
- Definition: A system of terminology and coding developed by the American Medical Association that is used for describing, coding and reporting medical services and procedures. CPT codes may also be referred to as HCPCS code Level 1.
A1CNow+ CPT Code Information:
- 83037: Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use.
A1CNow+ is approved for use with either a capillary or venous blood specimen.
Note 1: CPT code 83037 may be billed when an A1C test is performed in a provider’s office using a device cleared by the FDA for home use. CPT code 83037 is not intended to report an A1C test result that is obtained in a patient’s home by the patient or family.
Note 2: The QW modifier should be used when coding for Medicare and Medicaid beneficiaries. The QW modifier (83037QW) indicates that the test and laboratory have received a CLIA Certificate of Waiver. A1CNow+ has been categorized as a waived test under CLIA.
Note 3: 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.
Method of Blood Collection CPT Code Information:
- 36416: Collection of capillary blood specimen (e.g., finger).
- 36415: Collection of venous blood by venipuncture.
Pre-requisite for Testing
- CLIA Certificate of Waiver:
- A1CNow+® is classified as a CLIA waived test by the FDA.
- A CLIA certificate is required any time a clinical laboratory test is performed; however, performance of waived category tests requires only a CLIA Certificate of Waiver.
- Labs that perform waived testing must enroll in the CLIA program by obtaining the certificate, pay the certificate fee every two years, and follow the manufacturer’s instructions in performing clinical lab tests.
- To apply for a Certificate of Waiver, go to www.cms.hhs.gov/clia, download CLIA application form (CMS-116), follow the instructions provided, and send it to the appropriate state agency.
- A list of state agency addresses is also available on the internet at www.cms.hhs.gov/clia.
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.
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
- International Classification of Diseases, Ninth Revision, Clinical Modification. National Center for Health Statistics. Available at http://www.cdc.gov/nchs/about/otheract/icd9/abticd9.htm.
- Medicare Claims Processing Manual: Completing and Processing Form CMS-1500 Data Set, Chapter 26, Pages 13-15. Available at http://www.cms.hhs.gov/manuals/downloads/clm104c26.pdf.
- Medicare Claims Processing Manual: Physician/ Non Physician Practitioners: Evaluation and Management Service Codes, Chapter 12, Pages 33-34 and 43-44. Available at http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
- Cpt Handbook 2008. Introduction, Page xiv, published by the American Medical Association.
- Cpt Handbook 2008. Pathology and Laboratory, Page 274, published by the American Medical Association.
- Cpt Assistant, October 2006, Volume 16, Issue 10, Page 15, published by the American Medical Association.
- Food and Drug Administration. CLIA record K051321 and corresponding 510(k) premarket notification. Available at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCLIA/Detail.cfm?ID=8321.
- Cpt Handbook 2008. Surgery: Cardiovascular System, Page 134, published by the American Medical Association.