Pathology/Lab Coding Alert

Question: I-ve heard that there is a new G code for hemoglobin A1C testing, but I just got my new HCPCS book and I can't find it. What code should I use to bill this test for Medicare beneficiaries?

New Mexico Subscriber

Answer: CMS did propose to create a new HCPCS Level II G code for hemoglobin A1C (Gxxxx, Hemoglobin; glycosylated [A1C]) at the July 2007 meeting regarding Clinical Lab Fee Schedule pricing. The final CLFS, however, made no mention of the code, and no such code appears in HCPCS 2008.

Reprieve: The proposed G code would have added an administrative burden to labs by requiring them to use a distinct code for Medicare beneficiaries. Labs would continue using the appropriate CPT code for other payers as follows:

- 83036 -- Hemoglobin; glycosylated (A1C)

- 83037 -- Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use.

Because current pricing allows $7.50 more for 83037 than 83036, labs could have shouldered a financial burden from the G code as well, if it were priced at the 83036 level as expected.

Do this: Because the final fee schedule does not include the proposed G code, you should continue to bill these tests the same for all payers. Use 83036 for a standard A1C lab test that uses methods such as ion-exchange affinity chromatography, immunoassay or agar gel electrophoresis. Use 83037 for an A1C test using a device cleared for home use by the Food and Drug Administration.

Don't miss: The type of test, not the place of service, distinguishes 83036 from 83037. Whether the testing takes place at a hospital or an independent lab or a physician office, you should report 83037 for a self-contained A1C device that the FDA has approved for home use, such as Bio-Rad Micromat II Hemoglobin A1C, Cholestech GDX A1C Test, Metrika A1C, or Provalis Diagnostics Glycosal HbA1c Test.