Home Forums Discussions Problems urine drug testing in office

Not sure if this was covered previously.... if so, please redirect me to the appropriate thread...

I tried billing for a urine drug test cup in the office recently on a medicare patient using the new G0477, and it was denied as "billable, but not allowable", per the CMS rep. I told my biller to try the old G0434 code and it was rejected by her software as "code no longer usable". I'm confused as to how I can bill for this; I told her to resubmit without the QW modifier to see if that would work....

Any advice out there??

I'm no expert, but this is what we have been using.
ICD-10: Z79.891 High Risk Medication
CPT: G0434 -QW (In house Drug Test Cup)
Note: This is the only test that is CLIA waved, per my billing company, and required to be coded this was by Premera BCBS, Aetna, Medicare, and Medicaid. All others use:
CPT: 80300

So Boondoc, in your experience, Medicare is still accepting claims in 2016 for the G0434 -qw? My biller (as well as the blogs I've read) say that it was deleted on Jan 1, 2016....

This has worked up until recently. I'm not sure if there have been any drug tests on Medicare patients after 1/2016 for my office. I spoke with the billing department, and they said, "You know, what we are talking about here is like $3 of reimbursement." Sounds like a non-issue.

According to an aapc blog I read today, the correct code should be G0477 with no -qw modifier, and then after 4/1/16, the -qw modifier will be recognized and not create edits

Well, BCBS just rejected my G0434 -QW, so looks like the game is changing.

The new CMS code is G0477. It was activated on 1-1-16 and covers "read by direct optical observation" tests, such as dip strip drug tests or cups. You can submit one per date of service (I actually had a Dr. submitting 12 a day for a 12 panel UDS under the old code, and UHC was paying).

The CLIA waiver modifier, QW, is required, BUT there is a problem in the CMS system because they didn't link the QW modifier to the G0477 code, so if you submit G0477-QW it gets denied as "modifier not valid for date of service". My clearinghouse and AAPC recommend submitting G0477 without the QW modifier until after April 1st.