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What Is a Fair Charge for a Blood Glucose Test?

A blood glucose test is done to measure the amount of glucose in the patient’s blood using a reagent strip test method. Ancillary staff in a physician’s office or in a hospital typically collect the blood specimen for this test, using a finger stick and by placing a drop of blood on the reagent strip. After a brief period, staff compare the reagent strip to a color chart supplied by the test kit and determine the level of blood glucose by visual comparison or use the reagent strip with a glucose meter to obtain the blood sugar reading within seconds. Ancillary staff records or documents the test result in the patient’s medical record. This type of blood glucose testing is also frequently performed by patients when instructed in their home as part of diabetes self-management.

The current cost of reagent strips to assess blood glucose typically ranges from 40 cents to 70 cents per test strip. In this Audit Spotlight, we focus on the disparity of charges seen on healthcare claims for this frequently performed laboratory test (CPT code 82948, defined by the American Medical Association as Glucose; blood, reagent strip.)

Wide Disparities in Charges

Factors that can alter the charge for a blood glucose test include:

• Who performs and bills for the test — for example, a physician office or a hospital
• The locality (city/state) where the test is performed
• If the patient is insured or uninsured
• If the provider is in-network or out-of-network

Blood Glucose Test Performed in a Physician Office/Clinic

Lafyette, Indiana	$5
Indianapolis, Indiana	$5
Clearwater, Florida	$7
Newton, Iowa	$10
Louisville, Kentucky	$20
Gallatin, Tennessee	$22
Carrollton, Texas	$22
Warrenville, Illinois	$30
Chicago, Illinois	$52
Lima, Ohio	$75
Chesapeake, Virginia	$81
Winter Haven, Forida	$81
Plano, Texas	$82.50

 

Based on the 2025 Medicare Clinical Laboratory Fee Schedule, Medicare pricing for CPT code 82948 is $5.04 when reported/billed with a place of service (POS) code 11- “Office” on a CMS-1500 claim/electronic equivalent. ClaimDOC’s reference-based pricing is $6.30 or billed charge, if less.

Blood Glucose Test Performed in a Hospital Outpatient Department

(Medicare outpatient hospital pricing)

Annapolis, Maryland	$6.68 (hospital reported cost $2.32)
Tampa, Florida	$9 (hospital reported cost $1.14)
Holyoke, Massachusetts	$12.50 (hospital reported cost $3.92)
Tampa, Florida	$17.50 (hospital reported cost $1.68)
Durham, North Carolina	$37 (hospital reported cost $4.34)
Elkhart, Indiana	$42 (hospital reported cost $5.64)
Macon, Georgia	$60 (hospital reported cost $6.46)
Beloit, Wisconsin	$77 (hospital reported cost $8.09)
Indianapolis, Indiana	$85 (hospital reported cost $6.97)
Salinas, California	$137.09 (hospital reported cost $8.86)

 

Ambulatory Payment Classification is the payment methodology used by Medicare for hospital outpatient services and related reimbursement. APC groups services that require similar resources and have comparable clinical characteristics. Each group is assigned a Medicare payment rate based on the average cost of services within that group. When blood glucose test code 82948 is reported/billed with other hospital outpatient services/procedures, the blood glucose test is packaged, and Medicare pricing is based on the applicable APC specific to the surgical procedure and/or medical service reported/billed on the claim.

ClaimDOC’s reference-based pricing is based on using Medicare’s APC guidelines for outpatient hospital APC pricing with applicable markup with a comparison of the hospital’s cost-to-charge ratio with markup for services. ClaimDOC pricing is the higher of the two calculated rates. ClaimDOC pricing is the higher of the two calculated rates or billed charge, if less.

When laboratory tests are the only service reported/billed on a hospital outpatient claim, laboratory tests are priced per the Medicare Clinical Laboratory Fee Schedule with markup and comparison to the hospital’s cost-to-charge ratio with markup, pricing the higher of the two calculated rates. ClaimDOC pricing is the higher of the two calculated rates or billed charge, if less.

The Takeaway

Charges billed by physicians and hospitals for the same service (in this example, blood glucose testing — CPT code 82948) vary significantly. The above examples demonstrate both fair and egregious charges by healthcare providers. Whenever patients have the option, provider alternatives regarding where to seek care should be considered, and clear estimates of service charges should be requested prior to services.

ClaimDOC’s Comprehensive Claims Review and Goals

The improper reporting of healthcare services, coding/billing errors and egregious charges can complicate matters for members to understand their healthcare bills and payments, impact the collection of patient balances, build a reputation of providers charging high fees, create burdens for patients having no insurance, and a host of others.

When an individual receives a bill for healthcare services appearing questionable/inappropriate, an inquiry to the provider and/or health plan should be made to obtain an explanation of the service, corresponding charges and reimbursement.

Our goal at ClaimDOC is to use benchmark charges and costs nationally to negotiate fair and ethical payments. Our high-quality and expert review of claims identifies and prevents improper medical claim payments and maximizes long-term cost savings opportunities. Employers turn to us seeking to establish fair reimbursement rates for their plans allowing them to save money and provide richer benefits to their employees. A win-win for everyone.

Background

ClaimDOC’s comprehensive line-by-line review of claims uncovers errors that basic claim repricing and auto-adjudication do not catch, leading to greater savings for health plans and plan members. Our audit team analyzes all types of healthcare claims for a variety of potential concerns including excessive usual and customary charges, duplication of claims, incorrect coding, unbundling of services, and many others. Our claims review is not intended to impact care decisions or medical practice.