CurrentUnitedHealthcarePolicy N/A

Hemoglobin A1C testing frequency reimbursement

This UnitedHealthcare Community Plan reimbursement policy governs reimbursement and frequency limits for hemoglobin A1C (diabetes mellitus) testing billed on CMS-1500 or UB-04 forms for Medicaid products and affects all network and non-network providers submitting claims.

Policy Summary

PayerUnitedHealthcare

PolicyHemoglobin A1C testing frequency reimbursement

Policy CodePolicy N/A

Change TypeState exceptionsinitial publication

Effective DateN/A

Next Review DateN/A

Key ActionReimbursement allowed once every three months (90 days) per member for CPT 83036 or 83037; either code counts toward the frequency limit.

SourceLink

POLICY UPDATE CHANGES

State Exceptions: Washington DC added; Colorado and Rhode Island removed.

Policy published.

every 3 monthsallowed frequency for A1C testing for listed conditions

2 codesprocedure codes referenced (83036, 83037)

Medicaidprogram scope

Type 1 & 2conditions subject to frequency limit

multiplestate exceptions listed

Coverage Criteria for Hemoglobin A1C Testing

Coverage criteria for Hemoglobin A1C testing

Reimbursement is considered for the following procedure codes and conditions with a frequency limitation.

Procedure codes 83036 or 83037 are eligible for reimbursement when billed for Type 1 or Type 2 diabetes mellitus.

Frequency limitation: reimbursement allowed once every three months (90 consecutive calendar days) per member; this limitation applies regardless of billing or rendering provider; billing either procedure code counts toward the same limit.

When billed with conditions other than Type 1 or Type 2 diabetes mellitus, UnitedHealthcare will consider reimbursement and the once-every-three-months frequency limitation does not apply.

Applies to claims submitted on UB-04 or CMS-1500 forms for UnitedHealthcare Community Plan Medicaid products and to all provider types including network and non-network providers.

Policy Summary

PayerUnitedHealthcare

PolicyHemoglobin A1C testing frequency reimbursement

Policy CodePolicy N/A

Change TypeState exceptionsinitial publication

Effective DateN/A

Next Review DateN/A

Key ActionReimbursement allowed once every three months (90 days) per member for CPT 83036 or 83037; either code counts toward the 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.

Procedure Codes and Frequency

Hemoglobin A1C procedure codesCPTCovered

83036	Hemoglobin; glycosylated (A1C)
83037	Hemoglobin; glycosylated (A1C), by device cleared by FDA for home use

inv-03: Frequency limit — once every three months

Frequency limitOnce every three months (90 consecutive calendar days) per member regardless of billing or rendering provider.

Applies across providersLimitation is applicable regardless of billing and/or rendering provider (any individual provider or any facility) for each member.

Procedure code aggregationBilling either hemoglobin A1C procedure code (83036 or 83037) counts toward the same frequency limit.

ScopePolicy applies to hemoglobin A1C testing billed for Type 1 or Type 2 diabetes mellitus.

Provider Billing and Reimbursement Rules

Prior Authorization

Prior Authorization / Frequency Rule — A1C testing limited to once every 3 months

UnitedHealthcare will consider reimbursement of either hemoglobin A1C procedure code (83036 or 83037) once every three months (90 consecutive calendar days) when billed for the listed diabetes mellitus conditions. Billing either procedure code counts toward the same frequency limit; the limit applies per member regardless of billing or rendering provider and may result in denial if the member has already had an A1C test within the 90-day window.

Frequency limit: once every three months (90 consecutive calendar days) per member.
Either code 83036 or 83037 billed within the 90-day window counts toward the same limit.
Limit applies regardless of billing or rendering provider (any individual provider or any facility).
If billed more frequently than allowed, claim reimbursement may be denied.

Definitions

inv-05: Once every three months — definition/clarification

DefinitionOnce every three months — defined as 90 consecutive calendar days from the initial date of service.

Provider neutralityThe once every three months limitation is applicable regardless of billing and/or rendering provider for each individual member.

Code countingWhen billed, either A1C procedure code counts toward the once-every-three-months limit rather than each code having a separate limit.