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Supporting Our Providers in Improving Glycemic Rates for Members with Diabetes
Medical Mutual of Ohio·OH · Family Medicine, Internal Medicine, Endocrinology·Reimbursement
We identified it
Jun 20, 2026
Summary
Medical Mutual of Ohio is emphasizing proper billing and documentation for diabetes glycemic status assessments to improve HEDIS scores. Providers should bill CPT 83036 for HbA1c lab tests along with specific CPT II codes based on A1c/GMI results, and ensure proper medical record documentation with specific dates.
Action Required
Immediately: Billing team must ensure CPT code 83036 is billed for HbA1c lab tests along with the appropriate CPT II codes (3044F, 3051F, 3052F, or 3046F) based on A1c/GMI results. Providers must document A1c results with specific dates in medical records (avoid using 'recent' or 'last'). For GMI results, include the CGM data date range used to derive the value. Contact Medical Mutual provider representative to discuss supplemental data exchange opportunities to reduce medical record chart requests.