Attention Independent Clinical Labs Submitting Procedure Code 83036

A service-specific probe review was completed for CPT code 83036 glycated hemoglobin (A1C) for specialty 69 (Independent Clinical Lab). Major issues identified were documentation not received and services not medically reasonable or necessary. WPS Medicare must receive the documentation requested within 45 days or we will deny the service. It is important providers submit all requested documentation in a timely manner. It is not reasonable and necessary to perform procedure code 83036 more often than once every three months. Medical necessary documentation must support testing in excess of this guideline. The National Coverage Determination (NCD) 190.21 contains more information.

WPS Medicare MAC J5 for Iowa, Kansas, Missouri, and Nebraska