APPEALS FOR GLYCATED HEMOGLOBIN A1C TESTS – PROCEDURE CODE 83036

When submitting appeals for A1C tests (83036) you must describe the patient’s condition and include documentation, such as the A1C test results, to support the medical necessity for providing this service more frequently than once every three months. Also note that the Multi-Carrier System (MCS) begins the three-month count the day after the date of service billed. For example, if the date of service is December 15, 2011, then count day one as December 16, 2011. National Coverage Decision (NCD) 190.21 provides the medical necessity criteria. You can access this NCD at https://www.cms.gov/manuals/downloads/ncd103c1_Part3.pdf.