Hemoglobin A1c (HbA1c) (CPT 83036)
Medicare Rate vs. Lab Charges
Medicare pays $11.78 for this test. Labs commonly charge $40.00–$130.00. That's a 240%–1003% markup above what Medicare pays.
What This Test Is
HbA1c measures average blood glucose over the past 2-3 months. It's the gold standard for diagnosing and monitoring diabetes. Doctors order this regularly for diabetic patients and to diagnose prediabetes or diabetes.
Medicare Rate vs. Lab Charges
| Medicare Allowable Rate | $11.78 |
| Typical Lab Charge Range | $40.00–$130.00 |
| Average Markup Above Medicare | 240%–1003% |
Does Medicare Cover This Test?
Yes, Medicare Part B covers HbA1c. For diagnosis, it's typically covered once per year if results are normal; for monitoring diabetes, it's often covered 2-4 times per year depending on treatment.
Common Reasons for Denial
- Ordered more frequently than clinically appropriate (e.g., monthly without medication changes)
- No diagnosis of diabetes or prediabetes on record
- Duplicate test—same test done at another lab within 30 days
- Patient with well-controlled diabetes getting tested too frequently
- No medical record documentation of clinical indication
What To Do If You're Overcharged
If you received a lab bill that seems unusually high compared to Medicare rates:
- Check your Explanation of Benefits (EOB) from Medicare or your insurance to see what should have been paid.
- Request an itemized bill from the lab showing all charges.
- Compare to GougeStop rates for your area to see if the charge is reasonable.
- Contact the lab's billing department to dispute erroneous charges or negotiate a lower rate.
- File an appeal with Medicare if a claim was incorrectly denied.
Frequently Asked Questions
A: If you have diabetes, every 3-6 months is typical if your treatment is changing, or annually if stable. If you're prediabetic, once per year is common.
A: For diagnosis and monitoring, yes—HbA1c is often preferred because it doesn't require fasting. For acute blood sugar checks, fasting glucose or point-of-care testing is needed.
A: Urban labs and hospital systems often charge more. Independent labs may charge less. Geography and facility type heavily influence pricing.