HbA1c

Medicare coverage supports HbA1c testing at least twice yearly for patients with stable glycemic control (two consecutive results at goal) and more frequent testing—up to once every 3 months—for those with uncontrolled or unstable glycemia per Lab NCD 190.21. HbA1c may be unreliable in anemia, recent transfusion, hemoglobinopathies, or rapid red cell turnover, in which case alternative tests per NCD 190.21 should be used; local carrier policies (e.g., Palmetto GBA) may allow higher yearly testing limits and tests beyond standard limits require medical necessity documentation and may be reimbursed on appeal.

"Perform HbA1c testing at least twice per year in patients who are meeting individualized treatment goals and have stable glycemic control, defined as two consecutive HbA1c results meeting treatment..."

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