Wiki hemoglobin A1C coverage

[dragonclawz70]

Has anyone seen Medicare start reimbursing the hemoglobin A1C blood test yet using the screening diagnosis Z13.1? The CMS.gov website says in January of 2024 they're going to start covering hgb A1C for screening for diabetes, but so far I haven't seen any more of them get paid than they did before, which is not very much! I'm wondering if I should hold onto my denials and try resubmitting them in a couple of months.

 

[korthmm20]

We're having this issue too! We've been getting denials for every one we send out, and it's May now....

 

[Pam Warren]

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56686&ver=13

According to the LCA, that Z code is not covered as of 1/1/24.

 

[sls314]

It was effective January 1st, but it looks like it isn't being implemented until October 7, 2024.

According to this CMS transmittal released on May 2nd: https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/R12600BP.pdf

 

[dragonclawz70]

It was effective January 1st, but it looks like it isn't being implemented until October 7, 2024.

According to this CMS transmittal released on May 2nd: https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/R12600BP.pdf

Thank you for the link to that article, I appreciate the information!

 

[Cynthia Hughes]

A second CR13487 (R12694CP) was issued 06/21/24 with the same implementation date, 10/07/2024. Be sure to work with your MAC on getting the incorrect denials overturned as the CR states, "Effective for claims with dates of service on and after January 1, 2024, contractors shall not search claims but shall adjust claims brought to their attention."

 

[smihm]

Same here- we even rebilled a few in July for prior dates earlier in the year and denied . The MLN Preventive Service Chart for 2024 ( attached ) indicated you have to bill with "TS" modifier, In MM13487 published 06/2024 no mention- Is anyone using "TS" ?