CPT 83036: Hemoglobin A1c Test
83036 reports a hemoglobin A1c test, and Medicare pays it on the clinical laboratory fee schedule, not the physician fee schedule. Whether the test is CLIA-waived depends on the analyzer, and Medicare coverage rules limit how often a controlled patient can be tested.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 83036 is the hemoglobin A1c lab test, status X in the fee schedule file and priced on the clinical laboratory fee schedule. Some analyzers are CLIA-waived and need modifier QW. NCD 190.21 supports a test every 3 months for a controlled patient and says the test is not for diagnosing diabetes.
What Does CPT 83036 Report?
83036 reports a hemoglobin A1c test, the glycated hemoglobin measure used to judge long-term blood sugar control. It is a laboratory code, so the October 2026 fee schedule file (RVU26D) gives it status X, a statutory exclusion with no RVUs, and it is paid on the clinical laboratory fee schedule.
The same file lists 83037 separately as the home-device A1c, also status X. Do not swap them: 83036 is the lab test, and the home-device code describes a different setup.
| Item | Value |
|---|---|
| Payment status | X (statutory exclusion; no RVUs shown) |
| PC/TC indicator | 9 (concept does not apply) |
| Global period | XXX |
| Where it is priced | Clinical laboratory fee schedule |
| Practitioner MUE, Q4 2026 | 1 per date, indicator 2, rationale code descriptor |
| CLIA status | Depends on the analyzer; some are waived (QW) |
Is the A1c a CLIA-Waived Test?
It can be, but the answer belongs to the analyzer, not the code. Chapter 16, section 70.8 says every testing site needs a CLIA certificate, that the FDA approves waived tests, and that CMS identifies waived tests quarterly. To be recognized as waived, some tests have their own HCPCS code and some must carry modifier QW.
The CMS notice MM13455 lists 83036QW as a waived test effective September 27, 2023 for the Abbott Afinion 2 and AS100 analyzers. The CY 2026 CLFS update adds that QW both identifies codes and sets payment for tests done by a lab holding only a certificate of waiver. Section 70.8 sends complexity questions to the FDA's categorization database.
A lab holding only a waiver certificate that bills a test it may not run risks a CARC B7 denial; see the table below.
How Often Will Medicare Pay for an A1c?
National Coverage Determination 190.21 says measurement may be medically necessary every 3 months to see whether control is on target, and every 1 to 2 months when the regimen has changed or events may have altered control, such as surgery or glucocorticoid therapy.
Its limitations are firm. Testing a controlled diabetic patient more often than every 3 months is not reasonable and necessary, and for a diabetic pregnant woman the limit is once a month. Uncontrolled type 1 or 2 diabetes may need more than four tests a year, with documentation to support it. The NCD also says these tests are not considered medically necessary for the diagnosis of diabetes.
A glycated hemoglobin and a glycated protein test on the same day should be limited to the initial assay, after which glycated protein is used. Support the claim with a diabetes diagnosis such as E11.9. The practitioner MUE is 1 per date.
Can an A1c Be Billed Point of Care with a Visit?
Yes, as its own line. The test is a lab service paid on the CLFS under the lab's CLIA certificate, and the visit is billed separately, for example CPT 99214. Nothing in the fee schedule file ties the test to the visit.
A practice holding a certificate of waiver runs an A1c on a waived fingerstick analyzer during an established visit. The claim carries 99214 and 83036 with QW, 1 unit, and the practice's CLIA number in item 23.
A fingerstick is not a draw. Chapter 16, section 60.1 says a routine capillary puncture is not payable under the specimen collection fee, so 36415 does not belong on that claim; see CPT 36415.
How Does 83036 Appear on the Claim?
On the CMS-1500, item 24D carries 83036 with QW when required, item 24G carries 1 unit and item 24E points to the diagnosis. Item 23 carries the 10-digit CLIA number of the lab that ran the test (chapter 26), or REF02 with qualifier X4 on the 837P (chapter 16, section 70.10).
A claim with no CLIA number, or with more than one, is returned as unprocessable. When the number is missing, the remittance uses CARC 16 with RARC MA120. A claim from a lab that is out of compliance uses CARC B7 (section 70.11). Hospital outpatient lab codes on the CLFS take status indicator Q4 under chapter 4.
Which Fields Hold the A1c Test and CLIA Number?
An A1c test is one line, 83036 in Item 24D with QW if done on a waived device, and 1 unit in Item 24G. Item 23 holds the 10-digit CLIA number per Chapter 26. Item 24E points to the diabetes diagnosis, and Item 17 carries the ordering physician when someone else ordered it.
RVU26D marks 83036 as status X and the MUE table allows 1 per date with indicator 2, a policy edit.
Example: A patient with type 2 diabetes has an office A1c on 10/10. The line is 83036 QW, pointer A (E11.65), 1 unit, $14.00. A second A1c inside the payer's frequency window may be denied under CO-119.
Why Does an 83036 Claim Deny?
| CARC | What X12 says | What usually causes it |
|---|---|---|
| 119 | Benefit maximum for this time period or occurrence has been reached | Test repeated inside 3 months |
| 50 | Not deemed a medical necessity by the payer | Used to diagnose diabetes, not to monitor it |
| 16 | Claim/service lacks information or has submission/billing error(s) | No CLIA number, with RARC MA120 |
| B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service | Waiver-only lab billing a non-waived test |
If these denials keep coming back, our denial management team can work them. See also laboratory billing and endocrinology billing.
Related Codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- Clinical Laboratory Fee Schedule, CY 2026 annual update (MM14312) · CMS
- New Waived Tests (MLN Matters MM13455) · CMS
- Medicare Claims Processing Manual, Chapter 16: Laboratory Services · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- National Coverage Determinations Manual, Chapter 1, Part 3: section 190.21 Glycated Hemoglobin/Glycated Protein · CMS
- Medicare Claims Processing Manual, Chapter 4: Part B Hospital (Including Inpatient Hospital Part B and OPPS) · CMS
- Claim Adjustment Reason Codes · X12
- Remittance Advice Remark Codes · X12
We check every rule, code and deadline against the official source. See our editorial policy.
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01How do I bill an A1c in the office?
Bill 83036 as its own line with 1 unit, a diabetes or other supporting diagnosis, and QW when the test was run on a waived analyzer at a waiver-only lab. Put the lab's 10-digit CLIA number in item 23. The test is paid on the clinical laboratory fee schedule, not the physician schedule.
02Can an A1c be billed point of care with a visit?
Yes. The visit and the test are separate lines: the E/M is paid on the physician fee schedule and 83036 on the lab fee schedule. Run it on an analyzer your CLIA certificate allows, add QW where required, and do not add 36415 for a fingerstick.
03What does the QW modifier mean on 83036?
QW marks a CLIA-waived test. CMS notice MM13455 lists 83036QW as waived for certain analyzers from September 27, 2023, and the CY 2026 CLFS update says QW identifies codes and sets payment for labs holding only a certificate of waiver.
04How often will Medicare pay for an A1c?
NCD 190.21 supports a test every 3 months for a controlled patient, every 1 to 2 months after a regimen change, and monthly for a diabetic pregnancy. More than four a year for uncontrolled diabetes needs documentation. The MUE is 1 per date.
05Is 83036 the same as 83037?
No. The fee schedule file lists 83037 separately, with a label for a home device, and both codes are status X. 83036 is the laboratory test. Choose the code whose descriptor matches how the test was actually performed, and document the analyzer used.
A1c Claims Denied for Frequency or CLIA?
We check test frequency, QW and CLIA numbers before lab claims go out.