Medicare AdvantageBilling CodesHigh impact
Metabolic monitoring for patients on antipsychotic medications
Harvard Pilgrim Health Care·MA · Psychiatry, Family Medicine, Internal Medicine +2 more·Provider Newsletter
We identified it
Jun 26, 2026
Summary
Point32Health issued new guidance requiring annual metabolic monitoring (glucose, HbA1c, and cholesterol testing) for all patients on antipsychotic medications across all age groups. Billing teams must use specific approved CPT codes for these screenings and ensure proper documentation, especially for inpatient psychiatric discharges. This policy emphasizes care coordination among providers and includes a referral pathway for Tufts Health Together SMI members.
Action Required
Immediately: Billing team must update claim submission processes to recognize and correctly bill metabolic monitoring CPT codes for patients on antipsychotic medications. (1) For Glucose testing, use ONLY CPT codes 80047, 80048, 80050, 80053, 80069, 82947, 82950, or 82951. (2) For HbA1c testing, use CPT 83036 or 83037. (3) For LDL-C testing, use CPT 80061, 83700, 83701, 83704, or 83721. (4) For other cholesterol tests, use CPT 82465, 83718, 84478, or 83722. Providers and billing staff must ensure that: (a) Annual metabolic screening is documented on patient charts for all antipsychotic users; (b) Inpatient psychiatric discharge summaries include baseline metabolic testing results; (c) Discharge paperwork is shared with PCPs and community providers; (d) Claims include appropriate diagnosis codes linking to antipsychotic medication use to justify medical necessity. Update EMR templates and billing system edits to flag patients on antipsychotic medications requiring annual screening. Failure to use approved codes or provide proper documentation may result in claim denials for these preventive screenings.