What this is, in plain language
A blood test that estimates average blood sugar over the prior 2–3 months.
Why a clinician orders it
Diagnosing and monitoring diabetes and prediabetes.
Medical necessity — what insurers usually look at
Covered by Medicare and commercial plans for diabetes diagnosis and monitoring per CMS NCD 190.21. ADA guidelines recommend checking every 3–6 months in diabetics depending on control.
Documentation to ask about
- ✓Diabetes diagnosis or risk factors
- ✓Date of last A1c
Questions for your provider
- ?Is this lab in my network?
- ?How often should I be tested based on my control?
Why this code is in our seed set
Top-7 on the CMS Top 100 Lab Procedures Ranked by Services (~14 million allowed services).
Validated against
- •CMS Top 100 Lab Procedures Ranked by Services
- •CMS NCD 190.21 (Glycated Hemoglobin/Glycated Protein)
- •American Diabetes Association Standards of Care
Terms you'll see
Medical NecessityRead more →
The insurer is reviewing whether the service is clinically appropriate for your situation.
Important: AuraCode is an educational tool. It does not provide medical, legal, or insurance advice, claims decisions, or approval guarantees. Final coverage depends on your specific plan, eligibility, diagnosis, submitted documentation, and your insurer's review.