CG-LAB-25 Outpatient Glycated Hemoglobin and Protein Testing

This policy addresses outpatient testing of glycated hemoglobin (HbA1c) and other glycated serum proteins (e.g., albumin, fructosamine). Testing is covered as medically necessary for individuals ages 35–71 with overweight/obesity; for persons of any age from populations with disproportionately high diabetes prevalence; when hyperglycemia is found on other testing; and for pregnant individuals at high risk for type 2 diabetes; it is not covered when these criteria are not met or for any other indication.

"Glycated serum protein testing (for example, hemoglobin (HbA1c), albumin, or fructosamine) testing is consideredmedically necessaryfor any of the following indications (A-F):"

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