In a recent letter to CMS, the Academy stated its case regarding a 2006 CPT code for self-contained hemoglobin A1c testing systems for physician office use, recommending a payment of about $21 per test.
The purpose of this new code is to "create a new payment amount for A1c when this test is run in physician offices or other point-of-care locations where diabetes patients are treated and managed," wrote AAFP Board Chair Michael Fleming, M.D., of Shreveport, La. A code is needed that will "reflect the specific resource requirements, including practice expense and physician time, associated with new self-contained A1c tests," he said.
Fleming said the existing code is adequate for clinical laboratories and physician practices that see a high volume of patients with diabetes "because high test volumes result in low per-test cost."
"These economics are not available to the majority of physicians in primary care, even though 85 percent of patients with diabetes are treated by this physician group," said Fleming.
Fleming said that while hemoglobin A1c monitoring is a long accepted standard of care for patients with diabetes, studies show the test is vastly underutilized. He cited a study published in the June 26, 2003, New England Journal of Medicine that showed fewer than 24 percent of patients with diabetes have their hemoglobin A1c monitored according to established guidelines.
"We believe this new code and payment of around $21 … will provide access for all medical professionals who manage and treat patients with diabetes," said Fleming.
