CHANGES TO THE FREQUENCY AUDITING FOR A1C PROCEDURES

CMS has a Lab National Coverage Determination (NCD) policy for glycated hemoglobin/glycated protein, NCD 190.21. This NCD provides information on both the coverage and frequency limitations of these tests. The coverage determination is based on the diagnosis codes as listed in the NCD and the frequency shows Medicare will make payment once every three months. Any additional services must show medical necessity through the appeals process. WPS Medicare will activate an audit adjudicating claims based on the frequency guidelines above within the upcoming weeks. Providers who have received payment for these services on a more frequent basis should refund any excess payments to Medicare. You can find more information on a voluntary refund on our website: https://www.wpsmedicare.com

WPS Medicare: MAC for Illinois, Michigan, Minnesota, and Wisconsin