Summary & Overview
HCPCS Level II M1373: Glycemic Status Assessment, HbA1c/GMI 8.0–9.0%
HCPCS Level II code M1373 designates a documented most recent glycemic status assessment (HbA1c or GMI) with a result of 8.0% to 9.0%. This code captures a clinically important range of suboptimal glycemic control that can trigger treatment review, care management, or quality measurement. Nationally, consistent use of the code supports population health monitoring for diabetes and can inform payer care management programs and quality reporting.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical meaning of the code, typical sites of service where it is recorded, and how it fits into ambulatory diabetes monitoring workflows. The publication outlines common use cases for billing and documentation, summarizes what the code signals about patient risk and care needs, and highlights areas where payers may track this code for performance and case management. Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Billing Code Overview
HCPCS Level II code M1373 indicates a most recent glycemic status assessment with hemoglobin A1c (HbA1c) or glucose management indicator (GMI) level >= 8.0% and <= 9.0%. This code is used to document and bill for identification of a patient whose latest measured glycemic control falls within that specified range.
Service type: Glycemic status assessment / chronic disease monitoring
Typical site of service: Outpatient clinic, primary care office, endocrinology clinic, or other ambulatory care settings where diabetes monitoring and lab review occur
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with type 2 diabetes mellitus attends a primary care clinic for routine disease management. The clinic team reviews the patient’s recent glycemic monitoring, which includes a point-of-care hemoglobin A1c or continuous glucose-derived GMI performed within the measurement window. The most recent result is documented as 8.4%, which meets the billing descriptor for M1373 (most recent glycemic status assessment level ≥ 8.0% and ≤ 9.0%). Clinical workflow includes verification of the lab or device result in the electronic health record, clinician review of current medications and adherence, brief counseling on glycemic goals, and documentation of the numeric value and date of the test. The service is typically reported by outpatient primary care or endocrinology practices; actual billing may occur in clinic visits, chronic care management encounters, or quality reporting submissions. Typical site of service is an outpatient clinic or physician office, and the patient scenario assumes ongoing diabetes management rather than an acute hospitalization.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work or time exceeds typical for diabetes counseling documentation related to glycemic assessment and is appropriately justified. |