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83036 A1c denials

  1. #11
    Kansas City, MO
    Medical Coding Books
    I have also been told by Medicare they are having an issue with these, there are processing as 3 calendar months but the NCD reads 3 months, from what they have told me they are working with CMS on a resolution....last I checked they have still not resolved.

  2. #12
    Default Tda, ba, cpc
    Just and FYI if this is pertinent, per the National Coverage Determination, effective 8/1/2011, 83036 will no longer be covered under Medicare if performed more than 4 times per calendar year.

  3. #13
    Jackson, TN
    thank you so mucg for that info

  4. #14
    You are suddenly starting to get denials because patients are getting to the end of 12 month periods.
    Medicare will pay for 4 HgbA1c's in a 12 month period - not a calendar year.
    If the patient's DM is uncontrolled, or they have had changes to their diabetes medications you should appeal it with office notes.

  5. #15
    Jackson, TN
    How do you know it is a 12 month period and not a calendar year? what is the difference? Thank you

  6. Default
    Our clinic has contacted Medicare because ours were being denied even though we had a GA modifier on them. They stated that there was something wrong with their system and were not able to tell us if we would have to resubmit - or if they would automatically reprocess them when it was fixed. Just check with Medicare.

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