Reimbursement
Important news about reimbursement and billing for the A1CNow+.
- A new 2007 Medicare reimbursement amount is now available for CPT code 83037QW.
- The Medicare National Limitation Amount (NLA) is $21.06 in most states. Please confirm the payment amount with your local Medicare Carrier.
- Private payer rates vary by payer and plan type.
Please take the following steps in order to ensure you are taking advantage of this new reimbursement level:
1. Confirm that the 83037 QW code is active in your Medicare carrier region and use 83037 QW as the billing code for the A1CNow+ test. You can confirm the billing status by calling your local Medicare carrier directly or speaking with your sales representative.
2. Discontinue the use of 83036 QW to bill for the use of the A1CNow+. In most states, if you continue to use the 83036 QW code, your reimbursement amount will be lower.
For Assistance with Reimbursement Questions or denials specifically for CPT code 83037 Call Toll Free: 1-866-999-1415
Monday through Friday between 9am and 8pm (ET)
Resources:
Frequently Asked Questions on reimbursement and billing. You will find the answers to many questions: site/images/Questions_and_Answers.pdf
Medicare reimbursement rates by state: www.cms.hhs.gov/ClinicalLabFeeSched/02_clinlab.asp
PDF file of Medicare reimbursement rates by state: 2007 Clinical Diagnostic Laboratory Fee Schedule 04-24-07.pdf
American Medical Association, CPT Assistant, "Your Practical Guide to Current Coding", October 2006 Issue: Physician office based reporting for testing and interpretation of HbA1c results during a physician/patient encounter: CPTAssistant_Oct_06.pdf
Information on what do do about Claim Delays or Denials: Claim Delays 90743A FINAL.pdf
Claim Forms:
CMS1500 Claim Form provides examples of appropriate ICD-9 diagnosis codes to use as well as additional CPT codes that are appropriate to use with CPT code 83037QW, e.g. finger stick and venous draw: CMS_1500_claim_form_(8-05)_-_with_comments.pdf
The CMS1500 Claim Form replaces HCFA1500 Claim Form effective April 1, 2007.
HCFA1500 Form for use with CPT 83037: HCFA_form_1500_for_use_with_CPT_83037_-_with_comments.pdf