CPT 83036: Hemoglobin A1c (Glycosylated Hemoglobin)
CPT 83036 reports a glycosylated hemoglobin (HbA1c) test, which reflects average blood glucose over roughly three months and is central to diabetes monitoring. It is a clinical laboratory service priced under the Medicare Clinical Laboratory Fee Schedule (CLFS), not the Physician Fee Schedule, so it carries no PFS dollar amount.
- Code type
- Clinical laboratory test (chemistry)
- Priced under
- Medicare Clinical Laboratory Fee Schedule (CLFS), not the PFS
- Components
- Single analyte (glycosylated hemoglobin)
- Frequency notes
- Medicare: ~every 3 months for controlled diabetes; more often needs documentation
What is CPT 83036 used for?
CPT 83036 reports a hemoglobin A1c (HbA1c) test — a measure of glycosylated hemoglobin that reflects a patient's average blood glucose over roughly the prior three months. It is the standard tool for diagnosing and monitoring diabetes, guiding medication adjustment, and assessing long-term glycemic control.
Unlike a snapshot glucose, A1c averages control over time, which is why payers apply frequency rules tied to whether the patient's diabetes is stable or being actively adjusted.
How much does Medicare pay for 83036?
On the Physician Fee Schedule, 83036 shows status indicator X — statutory exclusion, so no RVUs and no PFS dollar. That is correct: lab tests are not paid on the PFS.
Payment comes from the Medicare Clinical Laboratory Fee Schedule (CLFS), priced with national limitation amounts and gapfill/crosswalk methodology. The Medicare fee calculator PFS lookup returns nothing for 83036 — reference the current CLFS rate from your MAC or payer fee file.
How often is 83036 covered?
Frequency is the number-one denial driver for A1c. Medicare's general pattern:
- Stable, controlled diabetes → about once every three months.
- Uncontrolled diabetes or a recent regimen change → more often (roughly every 1-2 months) when documented.
- Beyond the standard interval without documentation → expect denial for exceeding frequency.
Example: a patient whose insulin was just increased is retested at 6 weeks. The note documents the dose change and the goal of confirming improved control, supporting the earlier repeat.
How do medical necessity and ABNs apply?
Coverage follows the glycated-hemoglobin NCD/LCD, which lists covered diagnoses. If the indication is not covered or the frequency limit is exceeded, obtain an ABN before testing so the patient can accept financial responsibility. Link every order to a supporting diagnosis to satisfy payer medical-necessity rules. Point-in-time glucose (82947) answers a different clinical question than the A1c average.
Frequently asked questions
Because 83036 is a clinical laboratory test, not a physician service. On the PFS it carries status indicator X (statutory exclusion) and is never paid there. Payment comes from the Clinical Laboratory Fee Schedule (CLFS), which uses national limitation amounts and gapfill/crosswalk pricing. The PFS $0 is expected, not an error.
For a stable, controlled diabetic patient, Medicare generally covers HbA1c about once every three months. For uncontrolled diabetes or after a regimen change, more frequent testing (roughly every 1-2 months) may be allowed when the record documents the clinical need. Testing beyond the standard interval without support risks denial.
Coverage is driven by the applicable NCD/LCD for glycated hemoglobin, which lists covered ICD-10 codes (typically diabetes and related conditions). If the ordered indication is not on the covered list, or the frequency exceeds the limit, issue an ABN so the patient understands potential financial responsibility.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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