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HbA1c Testing Frequency

 

 

 


  The Office of Inspector General (OIG) has released its Fiscal Year 2011 Work Plan, which describes the investigative, enforcement and compliance activities that it will undertake in the coming year. OIG will review Medicare contractors for screening the frequency of clinical laboratory claims for HbA1c and determine the appropriateness of Medicare payments. The following testing intervals are considered medically necessary:  

  • Every 3 months to monitor a diabetic patient’s metabolic control
  • Every 1-2 months when treatment regimen is altered to improve control
  • Every month for diabetic pregnant women
  • Patients with uncontrolled type I or II diabetes may be tested more frequently if the medical record contains supportive documentation

  An Advance Beneficiary Notice (ABN) should be submitted for Medicare patients whenever a HbA1c is ordered at more frequent intervals than those listed above.  ... .

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