CurrentUnitedHealthcarePolicy N/A

Hemoglobin A1C testing frequency reimbursement

Defines UnitedHealthcare Community Plan Medicaid reimbursement and frequency limitations for hemoglobin A1C (diabetes mellitus) testing for affected providers and members.

Policy Summary

PayerUnitedHealthcare

PolicyHemoglobin A1C testing frequency reimbursement

Policy CodePolicy N/A

Change TypeAdministrative updatesstate exceptions

Effective DateN/A

Next Review DateN/A

Key ActionReimbursement will be considered for procedure codes 83036 and 83037 once every three months for listed conditions; billing either code counts toward the same frequency limit.

SourceLink

POLICY UPDATE CHANGES

State Exceptions: Washington DC added.

State Exceptions: Removed Colorado, Rhode Island.

Policy published 11/8/2025 and subsequent version changes including 2/1/2026 and 5/1/2026.

90 daysfrequency limitation (once every three months)

2CPT procedure codes listed

2Conditions explicitly listed

manyStates with exceptions listed

Reimbursement and Coverage Criteria

Reimbursement criteria for Hemoglobin A1C testing

UnitedHealthcare will consider reimbursement for hemoglobin A1C procedure codes when billed for the following conditions, subject to a once-every-three-months (90 consecutive calendar days) frequency limitation:

Reimbursement is considered for hemoglobin A1C procedure codes (CPT 83036 and 83037) when billed for the conditions listed below; frequency limitation applies once every three months (90 consecutive calendar days).

ONE OF

Type 1 Diabetes mellitus
Type 2 Diabetes mellitus

ALL of the following

Frequency limitation: Once every three months (90 consecutive calendar days) from the initial date of service.

Policy Summary

PayerUnitedHealthcare

PolicyHemoglobin A1C testing frequency reimbursement

Policy CodePolicy N/A

Change TypeAdministrative updatesstate exceptions

Effective DateN/A

Next Review DateN/A

Key ActionReimbursement will be considered for procedure codes 83036 and 83037 once every three months for listed conditions; billing either code counts toward the same frequency limit.

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.

Billing either procedure code (83036 or 83037) counts toward the same frequency limit.

The once-every-three-months limitation is applicable regardless of billing and/or rendering provider for the same member and date of service.

The frequency limitation applies only when the codes are billed for Type 1 or Type 2 diabetes mellitus; codes billed with other conditions may be considered without this limitation.

Procedure Codes and Frequency

Covered CPT CodesCPTCovered

83036	Hemoglobin; glycosylated (A1C)
83037	Hemoglobin; glycosylated (A1C) by device cleared by FDA

Frequency limit (quick reference)

Frequency limitOnce every three months (90 consecutive calendar days); billing either procedure code counts toward the same limit

Applies across providersLimit is applicable regardless of billing and/or rendering provider (any individual provider or any facility) for the same member and date of service

Applies to listed conditionsFrequency limitation applies when billed for Type 1 or Type 2 diabetes mellitus

Billing and Provider Requirements

Prior Authorization

Prior authorization / Frequency limitation — A1C testing reimbursable once every three months

UnitedHealthcare will consider reimbursement for hemoglobin A1C procedure codes 83036 and 83037 only once every three months (90 consecutive calendar days) when billed for Type 1 or Type 2 diabetes mellitus. Billing either procedure code counts toward the same frequency limit; the limitation applies regardless of billing or rendering provider for the same member and date of service.

Affected CPT codes: 83036, 83037
Frequency limit: once every three months (90 consecutive calendar days)
Either code billed counts toward the same frequency limit
Limitation applies regardless of billing or rendering provider for the same member and date of service
Frequency limitation applies only when billed for Type 1 or Type 2 diabetes mellitus

Terminology and Limits

Once every three months — definition

Definition — phraseOnce every three months = 90 consecutive calendar days

Scope — provider aggregationThe frequency is measured per member regardless of billing or rendering provider for the same date of service

Code countingEither hemoglobin A1C procedure code billed counts toward this once-every-three-months limit