Summary & Overview
HCPCS M1371: Glycemic Status Assessment, HbA1c/GMI < 7.0%
HCPCS Level II code M1371 designates documentation that a patient’s most recent glycemic status assessment—either hemoglobin A1c (HbA1c) or Glucose Management Indicator (GMI)—is below 7.0%. Nationally, tracking and reporting of glycemic control are central to quality measurement, chronic disease management, and performance-based payment arrangements for diabetes care. The code signals achievement of a commonly used clinical target for many adults with diabetes and can factor into quality metrics and value-based contracting.
This analysis covers major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how M1371 is used in documentation and reporting, typical care settings where the code applies, and the clinical context behind the < 7.0% threshold. The publication also outlines available benchmarks and common payer considerations where input is available, plus any recent policy updates that affect reporting and claims handling.
The piece is intended for billing managers, clinicians involved in diabetes care, and policy analysts seeking concise guidance on the code’s purpose, applicability across outpatient settings, and its role in quality measurement. Data not available in the input is noted where appropriate.
Billing Code Overview
HCPCS Level II code M1371 represents the most recent glycemic status assessment with a measured hemoglobin A1c (HbA1c) or Glucose Management Indicator (GMI) level < 7.0%. This code documents the achievement of a target glycemic control value for patients with diabetes.
Service type: Glycemic status assessment / Diabetes control measurement
Typical site of service: Outpatient clinic or ambulatory care setting, including primary care and endocrinology visits where laboratory results are reviewed and documented.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with type 2 diabetes mellitus attending a primary care or endocrinology visit for chronic disease management. The clinician reviews the most recent glycemic status measured by hemoglobin A1c (HbA1c) or continuous glucose monitoring-derived glucose management indicator (GMI) and documents a value < 7.0%. The workflow includes verification of the laboratory or CGM report in the electronic health record, interpretation relative to individualized glycemic targets, medication reconciliation, and incorporation of the result into the problem list and disease registry. This billing code M1371 is used to report the encounter-level assessment of glycemic control when the most recent documented HbA1c or GMI is below 7.0% during the reporting period.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work required to document or interpret glycemic status is substantially greater than typical (rare for lab reporting; use with supporting documentation). |