CPT code 83036: Hemoglobin A1c testing

CPT code 83036 is approved for use with ICD-10 diagnosis codes that support medical necessity for Hemoglobin A1c testing, primarily for diagnosing and managing diabetes. Common approved codes include E11.9 (Type 2 diabetes mellitus without complications), E11.29 (with kidney complications), and E11.319 (with unspecified diabetic retinopathy). Documentation must link the test to a relevant condition to ensure coverage and proper reimbursement.

CPT 83036 is used when the Hemoglobin A1c test is performed using a standard laboratory immunoassay method, typically in centralized labs. In contrast, CPT 83037 applies to tests performed with an FDA-cleared device for home use.

Under Medicare guidelines, CPT 83036 can generally be billed once every 3 months for patients with controlled diabetes, and more frequently if justified by changes in treatment or unstable glycemic control. Payers may have specific frequency limitations, so billing more than 4 times per year typically requires medical necessity documentation explaining the clinical reason for repeat testing.