Wednesday, December 4, 2019

CPT code 82985, 83036 - Glycated Hemoglobin/Glycated Protein Description


Procedure Code Description

82985 Glycated protein

83036 Hemoglobin; glycated


Glycated Hemoglobin/Glycated Protein Description


The management of diabetes mellitus requires regular determinations of blood glucose levels. Glycated hemoglobin/protein levels are used to assess long-term glucose control in diabetes. Alternative names for these tests include glycated or glycosylated hemoglobin or Hgb, hemoglobin glycated or glycosylated protein, and fructosamine.

Glycated hemoglobin (equivalent to hemoglobin A1) refers to total glycosylated hemoglobin present in erythrocytes, usually determined by affinity or ion-exchange chromatographic methodology. Hemoglobin A1c refers to the major component of hemoglobin A1, usually determined by ion-exchange affinity chromatography, immunoassay or agar gel electrophoresis. Fructosamine or glycated protein refers to glycosylated protein present in a serum or plasma sample. Glycated protein refers to measurement of the component of the specific protein that is glycated usually by colorimetric method or affinity chromatography.

Glycated hemoglobin in whole blood assesses glycemic control over a period of 4-8 weeks and appears to be the more appropriate test for monitoring a patient who is capable of maintaining long-term, stable control. Measurement may be medically necessary every 3 months to determine whether a patient’s metabolic control has been on average within the target range.

More frequent assessments, every 1-2 months, may be appropriate in the patient whose diabetes regimen has been altered to improve control or in whom evidence is present that intercurrent events may have altered a previously satisfactory level of control (for example, postmajor surgery or as a result of glucocorticoid therapy). Glycated  protein in serum/plasma assesses glycemic control over a period of 1-2 weeks. It may be reasonable and necessary to monitor glycated protein monthly in pregnant diabetic women. Glycated hemoglobin/protein test results may be low, indicating significant, persistent hypoglycemia, in nesidioblastosis or insulinoma, conditions which are accompanied by inappropriate hyperinsulinemia. A belownormal test value is helpful in establishing the patient’s hypoglycemic state in those conditions. HCPCS Codes (Alphanumeric, CPT? AMA)




Diabetes Care – Blood Sugar (HbA1c) (CDC / C15)  Diabetic members 18-75 years old

3 >76% Documentation of a hemoglobin (HbA1c) blood test in current measurement year date and result. HbA1c testing

• HbA1c control <8 .0="" br="">
• HbA1c poor control >9.0% HbA1c Tests CPT: 83036, 83037 HbA1c Level < 7.0 CPT II: 3044F HbA1c Level 7.0-9.0 CPT II: 3045F HbA1c Level > 9.0 CPT II: 3046F Exclusions: Gestational diabetes, steroid induced diabetes.






Diabetes Care – Blood Sugar(HbA1c) Controlled (CDC / C15)

Percentage of diabetic members 18-75 years old who have evidence of:

• HbA1c testing
• HbA1c control <8 .0="" br="">• HbA1c poor control >9.0%

3 >71% Documentation of a hemoglobin (HbA1c) blood test in measurement year date and result. HbA1c Tests CPT: 83036, 83037 HbA1c Level < 7.0 CPT II: 3044F HbA1c Level 7.0-9.0 CPT II: 3045F HbA1c Level > 9.0 CPT II: 3046F Exclusions: Gestational diabetes, steroid induced diabetes.





Diabetes HbA1c Test and Control 18-75 years (diabetics) HbA1c test during the measurement year with the most recent test =9%. CPT: 83036, 83037 CPT II: 3044F (if HbA1c<7 3045f="" 3046f="" 7.0="" hba1c="" if="">9%)

Diabetes HbA1c Test and Control* 18-75 years (diabetics) HbA1c test during the measurement year with the most recent test =9%.

CPT: 83036, 83037 CPT II: 3044F (if HbA1c<7 3045f="" 3046f="" 7.0="" hba1c="" if="">9%)


Covered ICD codes

ICD-10 CODED  ESCRIPTION


D13.7 Benign neoplasm of endocrine pancreas
E08.00 Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E08.01 Diabetes mellitus due to underlying condition with hyperosmolarity with coma
E08.10 Diabetes mellitus due to underlying condition with ketoacidosis without coma
E08.11 Diabetes mellitus due to underlying condition with ketoacidosis with coma
E08.21 Diabetes mellitus due to underlying condition with diabetic nephropathy
E08.22 Diabetes mellitus due to underlying condition with diabetic chronic kidney disease
E08.29 Diabetes mellitus due to underlying condition with other diabetic kidney complication
E08.311 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema
E08.319 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema
E08.3211 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye
E08.3212 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye
E08.3213 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral
E08.3291 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye
E08.3292 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye
E08.3293 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral
E08.3311 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye
E08.3312 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye
E08.3313 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
E08.3391 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye


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