M1372 Glycemic Status (HCPCS) Reimbursement

HCPCS Level II code M1372 denotes a documented most recent glycemic status assessment with an HbA1c or GMI result of at least 7.0% but less than 8.0%. This clinical result marker is relevant nationally for quality measurement, care coordination, and reporting in chronic disease management programs, particularly diabetes care. The code captures a specific intermediate glycemic control range that can inform risk stratification and treatment planning.

Key payers in scope for national consideration include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks and clinical context for interpreting M1372, an overview of payer coverage considerations, and guidance on where this result is typically documented. The publication outlines how this code fits into broader diabetes quality measurement and reporting workflows and highlights implications for outpatient and ambulatory laboratory settings. Any absent data fields from the input are noted as not available.

Billing Code Overview

HCPCS Level II code M1372 indicates a most recent glycemic status assessment (HbA1c or GMI) level >= 7.0% and < 8.0%. This code is used to document a measured glycemic result within that specified range for patients with diabetes or other conditions requiring glycemic monitoring.

Service Type: Glycemic assessment result reporting

Typical Site of Service: Outpatient clinic, laboratory, or ambulatory care setting where point-of-care or laboratory hemoglobin A1c testing is performed and documented

Data not available in the input.

Clinical Context

A 58-year-old patient with type 2 diabetes mellitus presents for routine chronic care management. The clinician orders a laboratory hemoglobin A1c test; the most recent result returns at 7.4% (within the range >= 7.0% and < 8.0%). The billing code M1372 is used to report the patient’s current glycemic status meeting the defined threshold. Typical workflow: the primary care or endocrinology clinician documents diagnosis and treatment plan in the electronic medical record, the laboratory processes the A1c, the result is reviewed during the visit or via telehealth, and the billing office links M1372 to the encounter for quality measurement or program reporting. Typical site of service includes outpatient clinic, primary care office, endocrinology clinic, or ambulatory care center. Common patient scenario includes medication adjustment, reinforcement of lifestyle interventions, or continuation of current therapy given an A1c in the specified range. Common modifiers applied to related billing may include 22, 52, 53, 54, 55, 62, AS, CO, CQ, QK, QX, QY depending on clinical circumstances and billing payor requirements.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional work beyond the typical service is documented for the visit associated with the A1c assessment.
`23`	Unusual anesthesia	Rarely applicable; used if anesthesia was required during an associated procedure in the same encounter.
`52`	Reduced services	Use when the full service related to the encounter was partially reduced or not completed.
`53`	Discontinued procedure	Use when an associated procedure was started but terminated before completion for patient safety.
`54`	Surgical care only	Use if billing separates surgical care from postoperative care when applicable to an encounter that also documents glycemic status.
`55`	Postoperative management only	Use when only postoperative management is billed separate from the operative episode.
`56`	Preoperative management only	Use when only preoperative management is billed separate from the operative episode.
`62`	Two surgeons	Use when two surgeons are involved in a procedure during an encounter that also documents the glycemic assessment.
`AS`	Ambulatory surgical center payment status	Use when services are furnished in an ambulatory surgical center and modifier reporting is required by payor.
`CO`	Services rendered in whole or part by a resident without an attending present	Use when a resident provided the service without direct attending presence and payor requires reporting.
`CQ`	Service furnished by a PA with clinical supervision by a physician who is not present	Use when a physician assistant furnishes the service under this supervision model.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Use when anesthesia medical direction circumstances exist in the same encounter.
`QX`	Service furnished by a CRNA with medical direction by a physician	Use when a CRNA provides anesthesia under medical direction during the encounter.
`QY`	Service furnished by a CRNA without medical direction by a physician	Use when CRNA provides anesthesia without physician direction.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians who commonly order and review A1c testing.
`207R00000X`	Internal Medicine	Internists managing chronic diabetes care and medication adjustments.
`207RE0101X`	Endocrinology	Specialists managing complex glycemic control and interpreting A1c trends.
`363L00000X`	Clinical Laboratory	Laboratory professionals performing the hemoglobin A1c testing and reporting results.
`208D00000X`	Nurse Practitioner	Advanced practice providers who frequently manage diabetes and document associated measures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E11.9`	Type 2 diabetes mellitus without complications	Common diagnosis for patients undergoing A1c measurement for glycemic control assessment.
`E10.9`	Type 1 diabetes mellitus without complications	Type 1 diabetes patients also undergo A1c monitoring to assess control.
`E11.65`	Type 2 diabetes mellitus with hyperglycemia	Relevant when A1c indicates suboptimal control within the specified range.
`E11.69`	Type 2 diabetes mellitus with other specified complications	Used when diabetes has additional complications influencing management decisions.
`O24.419`	Diabetes mellitus in pregnancy, unspecified, unspecified trimester	Pregnancy-related diabetes monitoring may include A1c depending on clinical context.
`R73.9`	Hyperglycemia, unspecified	Used when abnormal glycemic status is identified and further diabetes diagnosis is pending.
`Z79.4`	Long term (current) use of insulin	Indicates ongoing insulin therapy relevant to interpretation of A1c results.
`Z79.84`	Long term (current) use of oral hypoglycemic drugs	Indicates chronic oral therapy relevant to A1c management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`83036`	Hemoglobin; glycosylated (A1c)	Direct laboratory test that produces the A1c value used to determine `M1372` eligibility.
`82947`	Glucose; quantitative, blood (except reagent strip)	Point-of-care or laboratory blood glucose measurement often performed alongside A1c for immediate glucose status.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate severity	Common E/M service where A1c results are reviewed and management decisions are made; frequently billed with the A1c assessment.
`99091`	Collection and interpretation of physiologic data digitally stored and/or transmitted by patient and/or caregiver to the physician	May be used when remote monitoring data supplements A1c interpretation in chronic disease management.
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Used when ongoing care management for a patient with diabetes is provided and A1c monitoring is part of the chronic care plan.

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Summary & Overview

HCPCS Level II M1372: Glycemic Status HbA1c 7.0–7.9%