The Centers for Medicare & Medicaid Services will cut reimbursement for physicians who provide diabetic patients with point-of-care hemoglobin A1c testing using a “glycosylated Hb home device” from about $21 a test to about $13.50 a test on April 1, a coding expert from the American Academy of Family Physicians said.
The reimbursement cut was mandated by a provision in the Medicare, Medicaid, and SCHIP Extension Act of 2007, enacted at the end of last year. That provision reverses a decision by CMS in late 2006 to increase reimbursement for the HbA1c test, said AAFP coding specialist Cynthia Hughes, who noted that AAFP had lobbied hard for several years for the increase in reimbursement.
“It was slipped into SCHIP,” Ms. Hughes said. “It would take another act of Congress to reverse it.”
The language added to SCHIP legislation states that point-of-care HbA1c testing using the kit and billed under CPT code 83037 should be paid at the same rate as HbA1c testing done with an in-office analyzer in either a physician's office or laboratory setting and billed with CPT code 83036.
Ms. Hughes said that the average cost to physicians' offices for each test kit is about $13, but that costs also include shipping and handling of the kits themselves, staff time to administer the test, supplies, and additional overhead expenses. AAFP has suggested to CMS that an appropriate payment—one that takes into account all the costs of purchasing and administering the test—would be more than $34.
Providing the test at the point of care is more convenient for the patient and augments care because the test results are available in just a few minutes, in time for the physician to counsel the patient about those results, Ms. Hughes said.
The decreased reimbursement for the test kits could lead to fewer patients receiving the HbA1c test at the point-of-care, Ms. Hughes said, adding that reimbursement for testing using the in-office analyzers—which cost about $2,700—is not affected.