CPT 3052F Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

CPT 3052F: Hemoglobin A1c >8.0% and ≤9.0%

CPT code 3052F identifies a recent hemoglobin A1c (HbA1c) level greater than 8.0% and up to 9.0%, signaling suboptimal glycemic control in patients with diabetes. This performance-measure code is used in quality reporting and clinical documentation to characterize intermediate hyperglycemia that may prompt clinical reassessment of treatment and risk stratification. National relevance stems from diabetes prevalence, quality reporting programs, and payer performance measurement tied to HbA1c thresholds.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise interpretation of the code, the clinical context for the HbA1c range it represents, and what to expect in terms of service type and typical delivery settings. The publication summarizes how the code is applied in quality measurement and where it fits in laboratory and outpatient care workflows. Data not available in the input for payer-specific reimbursement, associated taxonomies, ICD-10 pairings, and related codes is noted as not provided.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 3052FHbA1cdiabetes monitoringlaboratoryquality measureoutpatient careendocrinologyprimary care

Billing Code Overview

CPT code 3052F indicates that a patient's hemoglobin A1c (HbA1c) result is greater than 8.0 percent and equal to or less than 9.0 percent. The HbA1c test reflects average blood glucose control over roughly three months and is used to monitor diabetes management.

Service type: Laboratory test — diabetes control monitoring

Typical site of service: Clinical laboratory, outpatient clinic, primary care office, or endocrinology practice

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with known type 2 diabetes mellitus who presents for routine chronic disease management in an outpatient primary care or endocrinology clinic. The care team orders a point-of-care or laboratory hemoglobin A1c (HbA1c) blood test to assess average glycemic control over the prior ~3 months. The result returned as a numeric percentage is >8.0% and ≤9.0%, prompting documentation of the elevated HbA1c value, review of medications, assessment of adherence and self-monitoring, evaluation for symptoms of hyperglycemia, and adjustment of the care plan (for example, medication intensification, referral to diabetes education, or closer follow-up). Typical sites of service include ambulatory clinic exam rooms, primary care offices, endocrinology clinics, urgent care centers that perform point-of-care testing, and outpatient laboratory draw stations. The patient encounter workflow commonly includes: pre-visit vitals and point-of-care HbA1c testing (or lab order and subsequent result), clinician review of the value (>8.0% to ≤9.0%), problem-focused or chronic care visit documentation, and coding of the HbA1c result with 3052F to indicate the most recent level in the specified range.

Coding Specifications

Modifier	Description	When to Use

CPT 3759F: Unclassified CPT Performance Measure

CPT-3513F-UNSPECIFIED-SERVICE

CPT 3513F: Unspecified Procedure or Measure

CPT-3455F-RHEUMATOID-ARTHRITIS-TB-SCREENING-PRE-DMARD-THERAPY

CPT 3455F: Rheumatoid Arthritis TB Screening Prior to DMARD Therapy

CPT-3096F-CENTRAL-DXA-SCAN-ORDER-TRACKING

CPT 3096F: Central DXA Scan Order Tracking

CPT-3725F-DEMENTIA-DEPRESSION-SCREENING

CPT 3725F: Depression Screening for Patients with Dementia

CPT-3502F-SPECIFIC-CLINICAL-SERVICE

CPT 3502F: Specific Clinical Service

CPT-3493F-UNKNOWN-SERVICE

CPT 3493F: Unspecified Procedure (No Summary Available)

CPT-3315F-ESTROGEN-PROGESTERONE-RECEPTOR-ASSESSMENT

CPT 3315F: Estrogen and Progesterone Receptor Status Assessment

CPT-3093F-NO-SUMMARY-AVAILABLE

CPT 3093F: No Summary Available

CPT-3271F-NO-SUMMARY-AVAILABLE

CPT 3271F: No Summary Available

Showing 1–10 of 199

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians commonly order and interpret `HbA1c` testing for outpatient diabetes management.
`207R00000X`	Internal Medicine	Hospital-based and outpatient internists manage diabetes and use `HbA1c` values for treatment decisions.
`207RE0101X`	Endocrinology	Specialists who manage complex diabetes cases and adjust advanced therapies based on `HbA1c`.
`163WH0700X`	Clinical Laboratory	Laboratories and lab directors responsible for performing the technical component of `HbA1c` testing.
`208000000X`	Nurse Practitioner	Advanced practice providers in primary care and specialty clinics who order and follow `HbA1c` testing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E11.9`	Type 2 diabetes mellitus without complications	Most common diagnosis associated with outpatient `HbA1c` monitoring and control assessment.
`E11.65`	Type 2 diabetes mellitus with hyperglycemia	Reflects inadequate glycemic control consistent with an `HbA1c` >8.0% and ≤9.0%.
`E10.9`	Type 1 diabetes mellitus without complications	Type 1 diabetes patients also undergo routine `HbA1c` testing to monitor control.
`O24.410`	Gestational diabetes mellitus in pregnancy, diet controlled, first trimester	Pregnant patients with diabetes have serial `HbA1c` monitoring as part of prenatal care when applicable.
`R73.9`	Hyperglycemia, unspecified	Used when elevated glucose levels are documented and further classification is pending; `HbA1c` helps establish chronic glycemic status.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`83036`	Hemoglobin; glycosylated (A1c)	Laboratory analyte code that identifies the `HbA1c` test itself when billed as a lab procedure; often reported by the performing lab alongside clinical quality codes like `3052F`.
`82947`	Glucose; quantitative, blood (except reagent strip)	Related point-of-care or laboratory blood glucose measurement used for immediate assessment of current glycemia; may be performed at the same visit.
`36415`	Collection of venous blood by venipuncture	Phlebotomy code for specimen collection when the `HbA1c` is sent to a central lab rather than performed point-of-care.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common E/M visit level used to document medication review and management in response to an elevated `HbA1c`.
`G0108`	Diabetes outpatient self-management training services, individual, per 30 minutes	Diabetes education and self-management training often provided following an elevated `HbA1c` result (use payer-appropriate diabetes education codes).

OpenPayer