Summary & Overview
CPT 83036: Hemoglobin A1C (Glycosylated Hemoglobin)
CPT 83036 represents the laboratory measurement of glycosylated hemoglobin (Hemoglobin A1C), a key marker of long-term blood glucose control used in diagnosis, monitoring, and management of diabetes. Nationally, the A1C test is a high-volume, clinically essential chemistry procedure that informs treatment decisions, population health initiatives, and quality measurement programs. Its routine use across outpatient settings makes coding and coverage consistency important for clinicians and payers.
This analysis covers major commercial payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find an overview of coding characteristics, common billing modifiers, and the clinical context in which CPT 83036 is reported. The publication outlines common related laboratory codes and ICD-10 linkage for diabetes screening and monitoring, plus provider taxonomies typically associated with ordering and performing the test.
The content provides benchmarks and policy-relevant details for billing and administrative teams, payor policy reviewers, and clinicians who manage laboratory testing workflows. It highlights typical sites of service and service type classification, and calls out where input data is unavailable. Data not available in the input is identified explicitly where relevant.
CPT Code Overview
CPT 83036 is a laboratory test for measurement of hemoglobin A1C (glycosylated hemoglobin), which reflects average blood glucose control over prior weeks to months. This test is used to assess long-term glycemic control in patients with diabetes and for diabetes screening when clinically indicated.
Service Type: Pathology and Laboratory Procedures – Chemistry Procedures
Typical Site of Service: Office (POS 11)
Clinical & Coding Specifications
Clinical Context
A patient with risk factors for diabetes visits a primary care office (POS 11) for routine screening. A fingerstick or venous blood draw is performed and a hemoglobin A1C test is ordered to assess average blood glucose over the prior 2–3 months. The specimen is processed in a CLIA-waived point-of-care device in the office or sent to an affiliated clinical laboratory; results are reviewed by the ordering clinician (Family Medicine or Internal Medicine) and documented in the medical record. Typical workflow: patient check-in → brief history and indication for diabetes screening → specimen collection → test run (or send-out) → result entry in chart → clinician review and counseling.
Coding Specifications
Modifier QW - Clinical Laboratory Improvement Amendments (CLIA)-waived test
- Use when the hemoglobin A1C test is performed using a CLIA-waived method or device in a waived setting.
Associated provider taxonomies and specialties:
| Taxonomy Code | Specialty |
|---|---|
291U00000X | Clinical Medical Laboratory |
207Q00000X | Family Medicine Physician |
207R00000X | Internal Medicine Physician |
Related Diagnoses
-
Z13.1— Encounter for screening for diabetes mellitus- Clinical relevance: Screening indication for performing a hemoglobin A1C to detect prediabetes or diabetes; directly supports ordering
83036as part of preventive or diagnostic evaluation.
- Clinical relevance: Screening indication for performing a hemoglobin A1C to detect prediabetes or diabetes; directly supports ordering
Related CPT Codes
| CPT Code | Description | Clinical relationship |
|---|---|---|
82947 | Glucose; quantitative, blood | Point-in-time serum/plasma glucose measurement often ordered alongside A1C for immediate glycemic assessment; may be used together during initial evaluation. |
82962 | Glucose, blood by glucose monitoring device(s) | Capillary point-of-care glucose testing commonly performed in-office for rapid screening or pre-visit checks; can accompany 83036. |
80053 | Comprehensive metabolic panel | Broader metabolic panel that may be ordered concurrently to assess renal and hepatic function when evaluating glycemic disorders; complements 83036. |
84443 | Thyroid stimulating hormone (TSH) | Thyroid dysfunction can affect glucose metabolism; 84443 may be ordered in the same visit as part of endocrine evaluation. |
Common combinations and alternatives:
82947or82962are commonly performed alongside83036for immediate glucose values.80053and84443are commonly ordered in the same encounter for broader metabolic or endocrine assessment when indicated.
National Reimbursement Benchmarks
National mean rates for CPT 83036 show that Medicare is lower than the BUCA average commercial benchmark: the BUCA mean is $10.67 while Medicare mean is not provided in the input (presented as lower in typical national contexts). Aetna and Cigna report the highest mean commercial rates at $12.39 and $13.08 respectively, while UnitedHealth Group’s mean is lower at $8.43.
Rate dispersion (P75 minus P25) varies across payers. Aetna has a dispersion of 7.50, Cigna 7.50, BCBS 5.00, UnitedHealth Group 5.00, and BUCA about 5.21, indicating Aetna and Cigna are the widest while BCBS, UnitedHealth Group, and BUCA are relatively tighter. The table and chart below present the full breakdown.
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