Coding Information

Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. 999 Not Applicable CPT/HCPCS Codes: Group 1 Paragraph: N/A Group 1 CPT Codes: 84378 SUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); SINGLE QUANTITATIVE, EACH SPECIMEN 84999 UNLISTED CHEMISTRY PROCEDURE ICD-10 Codes That Are Covered N/A XX000 Not Applicable ICD-10 Codes That Are Not Covered N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation 10/16/2025 R3 Revision Effective Date: 10/16/2025 CONTRACTOR INFORMATION: Added: JF contractor information This update is to consolidate JE and JF to have one unified document and policy number. 10/01/2019 R2 Updated to indicate this article is an LCD Reference Article. 10/01/2019 R1 10/01/2019: This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related GlycoMark Testing for Glycemic Control LCD L36864 and placed in this article. Under CPT/HCPCS Modifiers added modifier GX and GY.