CPT® Code 82947

Last Updated: January 2026 | Verified for 2026 AMA, CPT & CMS Guidelines

Quick Reference: CPT 82947

• Definition: Glucose; quantitative, blood (except reagent strip) — a laboratory-based, instrumented assay that yields a precise numeric blood glucose value from whole blood, serum, or plasma.
• Code Type: Clinical Pathology / Chemistry (Pathology & Laboratory section, CPT range 80047–89398). Billed on the Clinical Laboratory Fee Schedule (CLFS), not the Physician Fee Schedule (PFS).
• Medicare Rate (CLFS): Approximately $5.48 (verify annually via the CMS CLFS Look-Up Tool). No patient copay or deductible applies for Medicare CLFS tests.
• Governing NCD: CMS NCD 190.20 – Blood Glucose Testing.
• Panel Bundling Alert: Do not bill 82947 separately when a Basic Metabolic Panel (80048), Comprehensive Metabolic Panel (80053), or any other panel that includes glucose has been ordered. NCCI edits will deny the standalone code.
• Key Exclusion: This code does not cover glucose measurement by reagent strip (use 82948) or by an FDA-cleared home-use glucose monitoring device (use 82962).
• CLIA Requirement: Requires a standard CLIA certificate of compliance or accreditation. Not CLIA-waived.
• Diabetes Screening Frequency (Medicare): Up to 2 tests per year (at least 6 months apart) for pre-diabetic beneficiaries; 1 test per year for those never tested or previously tested normal. Use ICD-10 Z13.1 and modifier TS for pre-diabetes screening claims. CPT 82947 is the foundational code for quantitative blood glucose measurement performed in a clinical laboratory. It is one of the most frequently billed chemistry codes in the United States, appearing as a component in millions of metabolic panels and as a standalone test for diabetes management, perioperative monitoring, and screening. Unlike its cousins — the reagent strip (82948) or the home-use device code (82962) — CPT 82947 requires a laboratory-grade analyzer producing an exact, numeric glucose concentration, making it the standard for diagnostic accuracy and medical decision-making.

Understanding how to bill, document, and defend this code is essential for internal medicine physicians, endocrinologists, hospitalists, clinical laboratories, and their billing staff. Medicare governs coverage under National Coverage Determination (NCD) 190.20, which establishes both clinical indications and strict frequency limitations that, if violated, will result in claim denial and potential compliance exposure.

1. Code Definition, Descriptor, and Clinical Context

The official AMA CPT descriptor for code 82947 is:

Glucose; quantitative, blood (except reagent strip)

This code sits within the Chemistry subsection of the Pathology and Laboratory chapter of the CPT codebook (codes 82009–84999). It encompasses any laboratory-grade, instrumented, quantitative determination of glucose concentration in a blood specimen — whether whole blood, serum, or plasma — collected by venipuncture, arterial puncture, or capillary fingerstick, as long as the analysis is performed on a laboratory-grade analyzer and not on a simple reagent strip or FDA-cleared home-use glucose monitor.

The test is clinically essential for:

• Diagnosing diabetes mellitus and prediabetes (impaired fasting glucose), in conjunction with ADA diagnostic thresholds (fasting plasma glucose ≥ 126 mg/dL for diabetes; 100–125 mg/dL for impaired fasting glucose/prediabetes).
• Monitoring glycemic control in known diabetic patients who cannot or will not perform home monitoring, or in those whose home readings require laboratory confirmation.
• Perioperative glucose surveillance in surgical patients, ICU patients on insulin drips, and patients on total parenteral nutrition (TPN).
• Evaluating hypoglycemia, hyperosmolar hyperglycemic states, and diabetic ketoacidosis (DKA).
• Monitoring conditions associated with glucose dysregulation, including glucocorticoid therapy, enteral/parenteral nutrition, pancreatitis, Cushing’s syndrome, and acromegaly.
• Screening at-risk Medicare beneficiaries for diabetes mellitus under the Medicare Diabetes Screening Benefit (see Section 4). Important: CPT code selection is based on the analyte measured, not the method used to measure it. Per 2026 AMA and laboratory coding guidelines, you must use 82947 for quantitative glucose testing whether the analyzer uses enzymatic (glucose oxidase), hexokinase, or electrochemical methods — the instrumental technique does not change the code .

2. Methodology and CLIA Requirements

Accepted Analytical Methods Under 82947

All of the following laboratory methods yield a result reportable under CPT 82947, as long as the test is performed on a standard laboratory instrument (not a home-use meter or reagent strip):

• Hexokinase method (reference method): The gold-standard enzyme-coupled spectrophotometric assay used by most reference and hospital laboratories.
• Glucose oxidase method: A common spectrophotometric or electrochemical assay used on automated chemistry analyzers.
• Glucose dehydrogenase method: Used in some point-of-care systems that are laboratory-grade (not home-use classified).
• Spectrophotometry (SP): The generic methodology descriptor used by many reference labs when reporting the test (e.g., Diagnostic Laboratory of Oklahoma lists 82947 with SP methodology) .

CLIA Certificate Requirements

CPT 82947 is not CLIA-waived. Any entity performing this test — whether a hospital laboratory, physician office laboratory (POL), reference laboratory, or independent clinical laboratory — must hold at minimum a CLIA Certificate of Compliance or Certificate of Accreditation. This is a critical distinction from CPT 82962 (FDA-cleared home glucose device), which is CLIA-waived and can be performed under a Certificate of Waiver.

CLIA Compliance Alert: Physician office laboratories that use a laboratory-grade glucose analyzer (not a glucose meter cleared for home use) must maintain a CLIA Certificate of Compliance or Accreditation for this testing. Billing CPT 82947 without the appropriate CLIA certificate constitutes a false claim. Confirm your CLIA certificate type covers the complexity level of your instrument before billing. Visit the CMS CLIA website to verify certificate requirements.

Specimen Types

The code is valid regardless of the specific specimen type, as long as a laboratory analyzer is used:

• Serum (most common in hospital/reference labs — collected in a gold/red-top tube)
• Plasma (lithium heparin or EDTA tube — common for faster turn-around)
• Whole blood (capillary fingerstick processed on a laboratory-grade analyzer) Clinical note: Plasma glucose values are approximately 10–15% higher than whole blood values. If comparing results from different collection methods, clinicians should document which specimen type was used.

3. Medicare Coverage: NCD 190.20 — Indications & Frequency Limits

CPT 82947 is governed by CMS National Coverage Determination (NCD) 190.20 — Blood Glucose Testing, effective November 25, 2002 (with screening coverage added January 1, 2005). This NCD establishes that Medicare covers quantitative blood glucose testing when it is reasonable and necessary for the diagnosis or treatment of an illness or injury .

Covered Clinical Indications (NCD 190.20)

Medicare covers CPT 82947 for the following clinical scenarios, among others:

• Known diabetes mellitus (Type 1, Type 2, secondary, or gestational) requiring glucose monitoring
• Impaired fasting glucose (prediabetes) — monitoring for conversion to diabetes
• Insulin resistance syndrome and/or carbohydrate intolerance
• Hypoglycemia disorders (e.g., insulinoma, nesidioblastosis)
• Catabolic or malnutrition states
• Glucocorticoid therapy (steroids can cause significant glucose elevations)
• Unexplained chronic or recurrent infections (glucose dysregulation as an underlying cause)
• Alcoholism (risk of hypoglycemia)
• Coronary artery disease, especially in women (metabolic syndrome / glucose dysregulation)
• Unexplained skin conditions (pruritus, skin infections, ulceration, gangrene)
• Tuberculosis (associated glucose dysregulation)
• Patients presenting nonspecific signs and symptoms potentially related to glucose abnormalities
• Pre-surgical assessment in patients with known or suspected metabolic disorders

Frequency Limitations Under NCD 190.20

Medicare imposes frequency limits based on clinical status:

Where 82947 Is and Is Not Payable Under Medicare

CPT 82947 is a statutory exclusion from the Medicare Physician Fee Schedule. It is defined by CMS as a “non-physician service” — meaning it has no work RVUs and no payment amount under the PFS. It is only payable under the Clinical Laboratory Fee Schedule (CLFS). This is why physicians who attempt to bill 82947 from their office under a Type 11 NPI (individual provider) often receive N95 denial codes (“Provider type may not bill this service”) . The correct billing entity is the laboratory — either in-house or via a reference laboratory.

4. Diabetes Screening Benefit: Special Rules, Modifiers & Frequency

Effective January 1, 2005, CMS expanded Medicare coverage to include diabetes screening tests as a Medicare Part B benefit under 42 CFR §410.18. This is one of the most frequently misunderstood aspects of billing CPT 82947.

Eligible CPT Codes for Medicare Diabetes Screening

The following CPT codes are approved for the Medicare diabetes screening benefit:

• 82947 — Glucose; quantitative, blood (except reagent strip)
• 82950 — Glucose; post glucose dose (includes glucose)
• 82951 — Glucose; tolerance test (GTT), 3 specimens (includes glucose)

Eligible Beneficiaries

Medicare covers diabetes screening for beneficiaries who have one or more of the following risk factors:

• Hypertension
• Dyslipidemia (history of abnormal cholesterol/triglyceride levels)
• Obesity (BMI > 30 kg/m²)
• Previous identification of abnormal blood glucose levels
• Two or more other risk factors (e.g., age 65+, family history of DM, history of gestational diabetes)

Frequency Rules for Diabetes Screening

• 1 screening per year — for beneficiaries who have never been tested for diabetes, or whose previous tests were normal and who do not have a diagnosis of prediabetes.
• 2 screenings per year (at least 6 months apart) — for beneficiaries previously identified as pre-diabetic (impaired fasting glucose). CMS tracks frequency via the Common Working File (CWF); claims that violate the 6-month interval will auto-deny .

Required ICD-10 and Modifier for Screening

• Diagnosis code: Use Z13.1 (Encounter for screening for diabetes mellitus) as the primary diagnosis on the claim.
• Modifier TS: When billing a diabetes screening test for a beneficiary previously identified as pre-diabetic, you must append modifier TS (Follow-up service) to the CPT code. Failure to use TS when required will result in claim denial.
• No patient cost-sharing: There is no copayment, coinsurance, or deductible for Medicare-covered diabetes screening tests. This applies when the claim is billed correctly with Z13.1 and the appropriate frequency.

Where Screening Must Be Performed

CMS requires that Medicare diabetes screening tests be ordered and/or furnished in a primary care setting — defined as an environment where clinicians deliver integrated, accessible healthcare services, develop a sustained patient partnership, and practice within the context of family and community. This excludes: emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, and other non-primary care venues .

5. ICD-10-CM Diagnosis Codes: Medical Necessity Mapping

While CPT 82947 is diagnosis-agnostic (any valid, medically necessary indication can support it), the following ICD-10-CM codes are the most commonly linked and are recognized under NCD 190.20 and payer policies:

Coding Tip: Always include the most specific ICD-10 code available. For diabetic patients, always code the type of DM (E10 vs. E11 vs. E13), the complication or manifestation (hyperglycemia, hypoglycemia, etc.), and any relevant secondary codes (e.g., Z79.4 for insulin use). Vague codes like R73.09 alone may trigger ABN requirements or medical necessity reviews for repeat testing.

6. Panel Bundling, NCCI Edits & Unbundling Risks

This is one of the highest-risk billing areas for CPT 82947. The AMA CPT coding principle for organ/disease-oriented panels is clear: when all tests in a panel are ordered, bill only the panel code — never the individual component codes alongside the panel.

Panels That Include Glucose (82947)

When 82947 Can Be Billed Separately

CPT 82947 may be billed as a standalone code (without running into panel bundling rules) in the following circumstances:

• The provider ordered only a glucose test — no panel was ordered or performed.
• A glucose test is ordered separately on the same day as a panel, but for a clinically distinct indication using a different specimen collected at a different time. In this case, use modifier 91 (Repeat Clinical Diagnostic Laboratory Test) on the standalone 82947 to indicate it is not a duplicate billing.
• A panel was performed but not all required components of the panel were ordered — in this case, individual component codes (including 82947) may be billed, but the panel code cannot.

Duplicate Laboratory Service Rules

Medicare (and most commercial payers) will only reimburse one laboratory provider when duplicate laboratory services are submitted for the same patient on the same date of service. An important payer-specific note: some payers (e.g., certain ConnectiCare policies) explicitly state that 82947 and 82948 are excluded from duplicate laboratory service edits — meaning both may be payable on the same date if ordered and performed for distinct clinical purposes . Always verify payer-specific policies.

7. Modifier Usage for CPT 82947

Modifier 90 — Reference (Outside) Laboratory

Append modifier 90 when the ordering provider’s office or facility collects the specimen but sends it to an outside reference laboratory for analysis. The modifier signals pass-through billing — that the billing entity did not perform the test itself. The reference laboratory typically receives the majority of the reimbursement, while the collecting entity may bill a separate venipuncture fee (CPT 36415).

Example: A primary care physician orders a fasting glucose and draws the blood in the office. The specimen is sent to a reference laboratory for analysis. The physician office may bill 82947-90 (if contractually allowed to bill for the reference lab service) or may simply submit a specimen collection fee.

Modifier 91 — Repeat Clinical Diagnostic Laboratory Test

Use modifier 91 when the same test is repeated on the same patient on the same date for reasons other than confirming an initial result. This modifier is essential for:

• Patients who require serial glucose monitoring within a single day (e.g., pre- and post-procedure, or hyperbaric oxygen therapy patients requiring glucose checks each session)
• Separating a fasting glucose from a post-load glucose when both are performed on the same day Do not use modifier 91 to rebill a test because of equipment failure, specimen problem, or clerical error — those situations require cancellation and correction of the original claim.

Modifier TS — Follow-Up Service (Pre-Diabetes Screening)

As detailed in Section 4, modifier TS is required when billing the second Medicare diabetes screening test in a 12-month period for a beneficiary with a confirmed prediabetes diagnosis. Failure to apply this modifier will result in a Medicare denial for frequency violation.

Modifier QW — CLIA-Waived Test

Do not use modifier QW with CPT 82947. The QW modifier applies only to CLIA-waived tests. CPT 82947 is a non-waived laboratory test. If you are performing glucose testing with an FDA-cleared home-use glucose meter (which is CLIA-waived), you should bill CPT 82962, not 82947, and then append QW.

Modifier GA — ABN on File

When medical necessity is questionable and a valid Advance Beneficiary Notice has been issued and signed by the Medicare beneficiary, append modifier GA to the claim line. This shifts financial liability to the patient if Medicare denies the claim. Without modifier GA on a denied claim where an ABN was not issued, the laboratory cannot collect from the patient and must write off the service.

Modifier 59 / XP — Distinct Procedural Service

In rare circumstances where NCCI edits are being incorrectly applied to separate, distinct services (e.g., 82947 and another chemistry code performed on genuinely different specimens), modifier 59 (or the more specific XP — Separate Practitioner) may be used to override the edit. Use with caution and only with strong documentation of distinct clinical necessity.

8. Audit-Proof Documentation Standards

Clinical laboratory claims for CPT 82947 are subject to medical necessity audits by Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), and commercial payer audit programs. Unlike E/M codes, which require extensive note documentation, lab audits focus on whether the ordering provider’s clinical record supports the indication and frequency of testing. Both the laboratory and the ordering provider share compliance responsibility.

What the Laboratory Must Document

• Patient identifiers (name, date of birth, Medicare/insurance ID)
• Date and time of specimen collection
• Collector identity and CLIA certificate number
• Test ordered (as written by the provider — must match the billed CPT code)
• Specimen type (serum, plasma, whole blood)
• Result and units of measurement (mg/dL or mmol/L)
• Reference range
• Any critical value notifications made to the ordering provider
• ABN (if applicable) with patient signature and date

What the Ordering Provider Must Document (to Support Medical Necessity)

• Clinical indication: A clear diagnosis or signs/symptoms supporting the need for glucose testing. “Patient has Type 2 diabetes mellitus” is sufficient for periodic monitoring; however, documenting the specific reason (e.g., “adjusting insulin regimen; glucose trending up”) is best practice for repeat or high-frequency testing.
• Frequency justification: If ordering more than 4 glucose tests per year for a stable, non-hospitalized diabetic, the medical record must reflect why this frequency is medically necessary (e.g., “Patient unable to perform home glucose monitoring due to visual impairment and neuropathy in fingers. Quarterly laboratory glucose monitoring is medically necessary for glycemic management.”).
• Screening eligibility: For Medicare diabetes screening claims (Z13.1), document the specific risk factors that qualify the patient (e.g., “Patient has hypertension and BMI of 33.2. Ordering annual diabetes screening per CMS benefit.”).
• Standing orders: If glucose testing is on a recurring standing order, the order must include a specific timeframe, frequency, and clinical indication. Indefinite or undated standing orders are a common audit target. RAC and MAC Audit Trigger: High-volume billing of standalone CPT 82947 for stable, non-hospitalized diabetic patients — especially claims exceeding 4 per year per patient without additional documentation — is a recognized Recovery Audit Contractor (RAC) target. Ensure your documentation proactively supports frequency when it exceeds baseline guidelines.

9. Detailed Comparison: 82947 vs. 82948 vs. 82962

Key Takeaway: The most common real-world confusion is between 82947 and 82962. When a physician’s office uses a handheld POC glucose meter (even a clinical-grade one in a hospital or clinic), the correct code is 82962 (with modifier QW for CLIA-waived), not 82947. CPT 82947 is strictly for laboratory-grade analyzers. Using 82947 for a POC meter check constitutes upcoding and is a compliance risk .

10. Complex Clinical Billing Scenarios

Scenario 1: Annual Diabetes Screening in a Medicare Beneficiary with Hypertension

Patient: 68-year-old Medicare beneficiary with hypertension and obesity (BMI 32). No prior diabetes diagnosis. No prior diabetes screening on file with Medicare.

Setting: Primary care physician office. Blood drawn for fasting glucose only (no panel ordered).

Billing: CPT 82947, ICD-10 Z13.1. No modifier TS (first screening — not pre-diabetic).

Patient Cost-Sharing: None — no copay or deductible under the Medicare diabetes screening benefit.

Rationale: Patient has at least one qualifying risk factor (hypertension + obesity). Annual screening is covered. Do not bill an E/M with this claim unless a significant, separately identifiable service was provided (Modifier 25 on the E/M code).

Scenario 2: Second Screening for a Pre-Diabetic Medicare Patient

Patient: 72-year-old Medicare patient with documented impaired fasting glucose (prediabetes) from 7 months ago. Returning for second annual glucose screen.

Setting: Primary care office. Fasting blood glucose ordered.

Billing: CPT 82947-TS, ICD-10 Z13.1.

Patient Cost-Sharing: None — no copay or deductible.

Rationale: Modifier TS is mandatory for the second screening in a 12-month period for a pre-diabetic patient. Without TS, Medicare will deny the claim as exceeding the 1-per-year baseline limit. The 7-month interval satisfies the minimum 6-month separation requirement .

Scenario 3: Serial Glucose Monitoring During Hyperbaric Oxygen (HBO) Therapy

Patient: Diabetic patient undergoing hyperbaric oxygen therapy for a non-healing wound. Glucose must be checked before each HBO session. Multiple sessions in one day.

Setting: HBO clinic with laboratory-grade glucose analyzer.

Billing: CPT 82947 for first test; CPT 82947-91 for subsequent same-day tests.

ICD-10: E11.621 (Type 2 DM with foot ulcer) or appropriate wound/complication code.

Rationale: Modifier 91 is required to indicate repeat testing on the same day is medically necessary and not a billing error. Documentation should reflect the clinical protocol requiring glucose monitoring before each HBO session.

Note: If the clinic is using a bedside glucose meter (home-use device), the correct code is 82962-QW, not 82947. Using 82947 for a POC meter is a compliance violation.

Scenario 4: BMP Ordered — Can 82947 Be Billed Separately?

Situation: A hospitalist orders a BMP (80048) in the morning. In the afternoon, the patient’s glucose is rechecked due to a new hyperglycemic episode requiring insulin adjustment.

Billing (AM): CPT 80048 — BMP only. Do NOT add 82947.

Billing (PM): CPT 82947-91 with ICD-10 E11.65 (T2DM with hyperglycemia). The repeat afternoon glucose is a clinically distinct test on a different specimen at a different time for a new clinical reason.

Rationale: The AM panel bundles glucose within 80048 (no separate 82947 allowed). The PM standalone glucose is medically necessary for a new clinical event and is separable with modifier 91. Documentation must reflect the new indication for the afternoon test.

Scenario 5: Gestational Diabetes Screening During Pregnancy

Patient: 32-year-old pregnant woman at 24 weeks gestation. Physician orders a 1-hour glucose challenge test (post-load glucose) as routine GDM screening.

Billing: CPT 82950 (Glucose; post glucose dose, includes glucose) — not 82947.

ICD-10: Z34.22 (Supervision of normal second trimester pregnancy) or O09.522 (Supervision of elderly multigravida, second trimester).

Rationale: For post-glucose-load testing (1-hour or 2-hour), use 82950, not 82947. For a full 3-specimen oral glucose tolerance test (OGTT), use 82951. CPT 82947 is appropriate only for a simple fasting glucose in the GDM context if no post-load component is performed.

11. Commercial Payer Considerations

Coverage and frequency limitations for CPT 82947 vary by commercial payer, but most follow the general framework of CMS NCD 190.20. Key considerations include:

• Prior authorization: Generally not required for routine glucose testing. However, high-frequency serial testing (e.g., daily or multiple-times-daily inpatient testing billed by an outside lab) may trigger utilization management review.
• Coverage for non-diabetic indications: Most commercial payers follow NCD 190.20 logic for covered indications but may have proprietary Local Coverage Determinations or coverage policies. Always verify with each payer, particularly for less common indications (e.g., glucose testing for unexplained weight loss, tuberculosis workup, or SDOH-related conditions).
• Panel bundling rules: Commercial payers universally bundle glucose (82947) into metabolic panels. Billing 82947 alongside 80048 or 80053 will result in denial regardless of payer.
• CLIA certificate verification: Most commercial payers require a current, valid CLIA certificate identification number on the claim form (CMS-1500, Box 23 or electronic equivalent). Claims submitted without a valid CLIA number for non-waived tests will be denied .
• Place of service: The Place of Service (POS) code on the claim must accurately reflect where the test was performed. Mismatched POS codes (e.g., billing POS 11 Office when the test was performed in POS 81 Independent Laboratory) can trigger payer audits.

12. Compliance Pitfalls and OIG Risk Areas

The following represent the most common compliance failures associated with CPT 82947 billing:

• Using 82947 instead of 82962 for POC meter testing: The single most common upcoding error. Any glucose test performed with a handheld, FDA-cleared glucometer (even in a hospital or clinical setting) must be billed as 82962, not 82947. The device — not the setting — determines the code.
• Billing 82947 separately alongside a metabolic panel: A classic NCCI unbundling violation. Panels bundle glucose; never bill the component separately when the full panel was performed.
• Exceeding frequency limits without documentation: Billing more than 4 standalone glucose tests per year for a stable, non-hospitalized diabetic without documented clinical necessity is a RAC audit risk and potential overpayment.
• Missing modifier TS for pre-diabetic screening: Failure to append TS on the second Medicare diabetes screening claim for a pre-diabetic patient results in denial. This is an automated CWF edit — there is no appeal for incorrect modifier usage.
• Physician billing 82947 under the Physician Fee Schedule: As a statutory exclusion, 82947 has no PFS payment value. Billing it under an individual provider NPI (Type 1 NPI) will generate N95 denial codes. Only labs (Type 2 NPI) should bill this code.
• Lack of a valid CLIA certificate: Performing non-waived glucose testing (82947) without a Certificate of Compliance or Accreditation is a federal violation. All billers should verify CLIA certificate status matches the complexity of testing performed.
• ABN failures: When Medicare medical necessity is questionable and an ABN is not issued, the provider cannot collect from the patient if the claim is denied. Always issue an ABN proactively when testing falls outside NCD 190.20 parameters.