Widespread Service-Specific Probe Results for Hemoglobin A1C, CPT code 83036

Medical Review has completed an article for the Widespread Service-Specific Probe for Hemoglobin A1C, CPT code 83036. Records were reviewed to determine whether the procedure code billed met all documentation requirements for the services billed. Services for CPT code 83036 were denied if the documentation did not support the service billed as defined in the NCD 190.21 – Glycated Hemoglobin/Glycated Protein.

The major issues identified that led to the denial of 70.00% of these services are as follows:

• Requested documentation not submitted in a timely manner
• Services not documented in the medical records
• Services not medically reasonable/necessary

WPS Medicare MAC J5 for Iowa, Kansas, Missouri, and Nebraska; Legacy Medicare Part B for Wisconsin, Illinois, and Minnesota; MAC J8 for Indiana and Michigan