Fair Payment for Office Testing May Improve Diabetes Care

AAFP has taken its appeal for fair payment for administration of office-based hemoglobin A1c testing straight to Medicare carrier medical directors across the country.

In a Dec. 23 letter sent to nearly two dozen carriers, AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif., pointed out that payment for the testing should be set at no lower than $21.06 and suggested that a more accurate payment would be at or above $34.

According to Frank, CMS is letting carriers set the payment rate for hemoglobin A1c testing locally using available information sources within their service areas -- a process called "gap filling" -- rather than setting a national payment rate.

Frank outlined the costs shouldered by primary care physicians who administer the test, including

"Accordingly, a gap-fill amount that accounted for the resources required to perform the test would likely be at or above $34," said Frank.

Frank also emphasized the importance of improving access to hemoglobin A1c testing in the primary care setting, noting that "diabetes management in the U.S. is inadequate, with overall worsening status in patients treated within the primary care setting." According to Frank, family physicians treat about 85 percent of people with diabetes.

She said that "real-time A1c testing is presently unavailable to most primary care physicians because they do not run enough A1c tests to justify the purchase of an instrument." By setting appropriate gap-filling payments for A1c testing, physicians will be able to purchase self-contained systems -- represented by CPT code 83037 -- which will increase access for practices or in situations where a low volume of tests is conducted, said Frank.