AAFP Prevails in Battle to Increase Medicare Payment

The Academy's persistence in asking CMS to increase payment to physicians who administer point-of-care hemoglobin A_1c testing appears to have paid off.

According to the recently released 2007 Clinical Diagnostic Laboratory Fee Schedule, (scroll to the "Downloads" section of the page to download the file titled "07CLAB.ZIP [Text, Excel, MS Word Zipped, 1.8MB]") the payment rate for CPT code 83037 -- defined by CMS as "glycosylated hb home device" -- will increase to $21.06. Currently, more than half of the 56 Medicare carriers pay physicians just $13.56.

That's good news for family physicians, said AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky., who pointed out that the payment increase also would likely increase physician use of the office point-of-care testing kit as opposed to off-site lab hemoglobin A_1c testing. "Point-of-care testing will allow physicians to better monitor their patients with diabetes," he said.

"This 55 percent increase in payment for in-office hemoglobin A_1c testing is a major step forward in promoting the use of technology within the patient's medical home," said Fields. "We will work closely with CMS to continue this trend because it's good for our members and good for their patients."

The Academy's fight for higher payment for in-office testing dates back to July 2005 when it requested that CMS set the payment rate for CPT code 83037 no lower than $21.06 and suggested a more accurate payment would be more than $34. In making its case to CMS, AAFP broke out testing costs to physicians to include about $13 for the test kit, shipping and handling fees, staff time to administer the test, supplies, and additional overhead expenses.

In addition, during the past 18 months of dialogue with CMS about the payment issue, the AAFP continually highlighted several key points: