Physician Payment Cut for Some Diabetes Testing

Family physicians who provide point-of-care hemoglobin A1c testing using a test kit that CMS defines as a "glycosylated hb home device" will see a drop in Medicare payment -- from about $21 per test to about $13.50 per test -- beginning April 1.

The pay cut is the direct result of an amendment that was tucked into Section 113 of the Medicare, Medicaid and SCHIP (State Children's Health Insurance Program) Extension Act of 2007, S. 2499, (at the THOMAS Web site, type "S 2499" in the search box after selecting "Bill Number") that was passed by Congress in mid-December.

Physicians may be in the middle of ordering supplies of the multiple-use disposable kits, and the cut in payment may make it difficult for them recover their costs, said Cynthia Hughes, C.P.C., an AAFP coding specialist. The average list price for purchasing the test kit is around $13, but physicians incur additional shipping, overhead and staff expenses that are not reflected in the lower payment amount, she added.

Physicians testing patients with the more expensive in-office analyzers -- which cost around $2,700 -- are not affected by the change, said Hughes.

Language in the amendment to the bill mandates that point-of-care A1c testing performed with the test kit and billed by physicians with CPT code 83037 be paid at the same rate as A1c testing done with an analyzer in a physician's office or laboratory setting and billed with CPT code 83036.

The payment reduction is particularly distressing in light of the Academy's successful efforts late in 2006 to convince CMS to increase payment to physicians who were using the lower-cost test kit.

In its past dialogue with CMS on the issue, the Academy had argued that family physicians treat about 85 percent of people in the United States who have diabetes. Academy leaders told CMS that improved access to hemoglobin A1c testing would help family physicians better care for their patients with diabetes at a time when studies showed an overall worsening status among diabetic patients treated in the primary care setting.