CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB004

Diabetes Mellitus Testing

Reimbursement and coding criteria for laboratory testing related to diabetes mellitus (eg, fasting plasma glucose, hemoglobin A1c, OGTT) for Blue Cross Blue Shield of Oklahoma; governs provider claim submission and reimbursement determinations.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyDiabetes Mellitus Testing

Policy CodePolicy CPCPLAB004

Change TypeNew and revised reimbursement statementscoding list added

Effective DateAug 15, 2023

Next Review Date

Key ActionSubmit accurate documentation and use HIPAA-approved code sets; BCBSOK may request additional documentation for claim review.

SourceLink

POLICY UPDATE CHANGES

New policy created and published with literature review and reimbursement statements.

Reimbursement information updated with new and revised numbered statements (#1, #3, #4, #5, #6, #9, #10).

Procedure code list provided (82951, 82952, 82985, 83036, 83037).

5procedure codes listed

1.0policy version

2023-08-15plan effective date

3Notes added

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyDiabetes Mellitus Testing

Policy CodePolicy CPCPLAB004

Change TypeNew and revised reimbursement statementscoding list added

Effective DateAug 15, 2023

Next Review Date

Key ActionSubmit accurate documentation and use HIPAA-approved code sets; BCBSOK may request additional documentation for claim review.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Reimbursement criteria for diabetes-related tests

Reimbursable situations for fasting plasma glucose, hemoglobin A1c, and oral glucose tolerance testing (OGTT) are described below. Coverage is limited to the specific diagnostic, monitoring, screening, population-specific, and numbered notes listed.

ALL of the following

Fasting plasma glucose (diagnostic/screening)
- Individuals with acute or persistent classic symptoms of diabetes mellitus (diagnostic)
  See Note 1 for ADA diagnostic guidance.
- Annual screening for prediabetic individuals using fasting plasma glucose or hemoglobin A1c
- ALL of the following
  - Risk factors: overweight or obese; history of cardiovascular disease; first-degree relatives with diabetes; hypertension; hypercholesterolemia; metabolic syndrome; obese with acanthosis nigricans; history of gestational diabetes mellitus (GDM); polycystic ovary syndrome
- Screening in HIV-positive individuals using fasting plasma glucose may be reimbursable when: at ART initiation; when switching ART; 3–6 months after starting or switching ART; or annually if initial screening was normal
Hemoglobin A1c (monitoring/diagnostic)
- Upon initial diagnosis to establish a baseline value and determine treatment goals
- Quarterly (every 3 months) in individuals who are not meeting treatment goals for glycemic control
- Twice a year (every 6 months) in individuals who are meeting treatment goals and who appear to have stable glycemic control based on daily glucose monitoring
- Quarterly in individuals whose pharmacologic therapy has changed
- Hemoglobin A1c is not reimbursable for other situations not previously described
  See Note 3 for situations where hemoglobin A1c should not be performed.
OGTT (oral glucose tolerance test)
- Annual screening with OGTT for cystic fibrosis (CF)-related diabetes in individuals >=10 years of age with CF who have not been diagnosed with CF-related diabetes
- ALL of the following
  - Pediatric risk factors: family history of type 2 diabetes in first- or second-degree relatives; maternal history of diabetes or GDM during gestation; signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, PCOS, or small for gestational age birth weight)
- For pregnant individuals, fasting plasma glucose or OGTT up to once per month during pregnancy may be reimbursable
- For individuals diagnosed with GDM during pregnancy: OGTT reimbursable to screen for persistent diabetes or prediabetes 4–12 weeks postpartum; if initial postpartum screening is positive, repeat OGTT to confirm diagnosis

Procedure codes and frequency guidance

Listed procedure codesCPT

82951	Glucose; post glucose dose (postprandial), quantitative
82952	Glucose; tolerance test (GTT), multiple samples
82985	Glycated hemoglobin (eg, A1c), per patient
83036	Hemoglobin; glycosylated (A1c)
83037	Hemoglobin; glycosylated (A1c) by device cleared by FDA for home use

OGTT frequency for specified populations

CF-related diabetes (OGTT)Annual OGTT screening for individuals aged 10 years and older diagnosed with cystic fibrosis (CF) but not with CF‑related diabetes.

Pregnancy screening frequencyFasting plasma glucose or OGTT up to once per month during pregnancy when indicated.

GDM postpartum OGTTOGTT to screen for persistent diabetes or prediabetes 4–12 weeks postpartum for those diagnosed with gestational diabetes; repeat testing if initial postpartum screen is positive.

Documentation and claim submission requirements

Documentation Required

Documentation and claim submission requirements

Providers must submit accurate documentation and submit claims using valid HIPAA-approved code sets; claims are subject to coding edits, claim review, and provider contract terms. BCBSOK may request additional documentation and will interpret/apply this policy consistent with plan documents and provider contracts.

Submit claims coded using valid code combinations from HIPAA-approved code sets (eg, CPT, HCPCS, ICD-10-CM/PCS, NDC).
Claims are subject to code edit protocols, claim review, and may be reviewed against benefit coverage, provider contract language, medical policies, and coding software logic.
Upon request, provide any additional documentation BCBSOK requires.

Key definitions and notes

Definitions — familial relationships

First-degree relativesParents, full siblings, and children of the individual.

Second-degree relativesGrandparents, aunts, uncles, nieces, nephews, grandchildren, and half-siblings of the individual.

Use in screening criteriaFamily history in first- or second-degree relatives is a listed risk factor for diabetes screening in children and adults per policy criteria.

Hemoglobin A1c — exceptions (Note 3)

Pregnancy (undiagnosed)Do not perform hemoglobin A1c in pregnant individuals not already diagnosed with diabetes.

Individuals under 18 (undiagnosed)Do not perform hemoglobin A1c in individuals under 18 years of age who are not already diagnosed with diabetes.

Conditions with increased RBC turnoverDo not perform hemoglobin A1c in individuals with conditions associated with increased red blood cell turnover (e.g., sickle cell disease, hemodialysis, recent blood loss or transfusion, erythropoietin therapy).

Fructosamine testingDo not perform hemoglobin A1c in conjunction with measurement of fructosamine.