Billing Hemoglobin A1c Labs for Blue MA Patients

When providing an HbA1c in your office, to ensure prompt claim processing for your Blue Medicare Advantage (MA) members, submit the distinct numeric results as $0.01 on the HbA1c claim with the appropriate CPT® II code for HEDIS® compliance:

HbA1c labs (e.g. 83036 and 83037) with an office place of service without the appropriate CPT® II code reporting the HbA1c level will be rejected for additional information.

Reporting the HbA1c level through claims also helps close gaps in care and capture eligible incentives for Kansas Preferred Blue MA providers with attributed members. As such, adding the reporting code on these claims ensures appropriate service and incentive payment, reduces administratively burdensome and costly records requests, and helps capture the true disease state of the patient for healthcare quality reporting.

For additional information on the HEDIS® Comprehensive Diabetes Care measures, including Hemoglobin A1c Control for Patients with Diabetes (HBD), refer to the tip sheets and content located in our convenient 2023 Understanding Star Ratings Guide.

If you have questions regarding this publication, please contact your BCBSKS MA provider representative.

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