EmblemHealth's 2026 incentive to a primary care provider for each HbA1c result reported as a CPT II result code (any result band pays the same)

$10

USD per HbA1c test result reported (paid to the provider, up to 4 a year per member), US (New York)

“EmblemHealth will reimburse primary care providers for the utilization of CPT category II codes to address key quality measures. Reimbursement will include CPT II codes submitted from January 2026 onward. ... 3044F - HbA1c less than 7.0 percent 3046F - HbA1c greater than 9.0 percent 3051F - HbA1c greater than 7.0 percent and less than 8.0 percent 3052F - HbA1c greater than or equal to 8.0 percent ... One of these codes (as applicable) can be used up to 4 times per year, per member. Incentive $10 (up to 4 times, i.e. $40 max)”

EmblemHealth, "2026 Quality Incentive Program: CPT II Code Incentive" provider flyer, 2026-01

Kind of source

The payer's or seller's own page

Read on

2026-11-07

Daily check

Quote found at the source on 2026-11-07

What to know

A health plan's current published price for one lab value, paid to the practice (not the patient) for reporting the HbA1c band on the claim, whatever the result, to support the plan's quality measurement. It buys a coded result band for the plan's own use and includes the practice's coding work, so it is not a research licence.

Arithmetic

Stated per result; no arithmetic. At most 4 x $10 = $40 a year per member, as the flyer states. Filed as side cost by the operator: a health plan paying a practice to code and report one result for its own quality measurement is what it costs that buyer to obtain the result, not a research licence price.

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