Wiki 80101 bluecross


Jackson, TN
Best answers
Good afternoon.
I need to know if anyone else is having problems with this.
With commerical blue cross we have been billing uds 80101 X 9 units with V58.69.
The have not been denying this but we just received a letter from Blue cross recouping $30,000 stating we were supposed to be billing only 1 unit..
So we are thinking we will start billing 80101 x 1 unit and on the next line 80101, 91 modifier and 8 units..
Does anyone else have a suggestion on have this problem?
80101 Blue Cross

Were you able to obtain guidance regarding this question? Which state plan of Blue Cross?
I don't understand BCBS rationale. If you have a 9 panel test, you should be able to charge 9 units. Medicare guidelines require you to only submit one unit, I believe. I would like to know if you received an answer.
It all depends on CLIA status, then look at what the test is ex: cup,strip,ext.. If your in office lab is CLIA waived and you use a test that is visual the correct code is 80104 QW at 1 unit. Let me know if you need help!

Jacqueline Nickoles, CPC
Rehab and Neuro
We are having the same problem here in Washington State. Regence has started recouping payments as well. We were initially advised to bill 80101 x 10 with -91 modifier. After a few months, they change "their policy" and stated that can only be billed once, even though we are a high complexity lab with CLIA Certification.

After we spoke with a supervisor from Regence, she suggested we start billing 80104 and we would be reimbursed at 100% of Regence allowable. After 2-3 payments of $400 or so, they changed "their policy" again and are in the process of recouping those 2-3 payments. Now, we are getting reimburse at only $50 for 80104, whereas we avg $200 for other major carriers in the NW United States.

So, we are lost as well. We will try to bill 80104 x 10 with modifier-91, but I think they will reject it saying that the procedure is "bundled."

Tell me what you guys think.
We were told by the drug testing rep to bill 80101 x 10 to all carriers except Medicare. For Medicare, we bill G0434 x 1. We haven't had a recoupment yet, but I'm afraid that it will happen eventually. I think the correct code is 80104 x 1, but this has created a HUGE controversy in our office. Any thoughts would be appreciated.

Our office has been trying to get paid for using the urine screen drug test. The cup actually shows what is hot. The code that they said to use was G0434/QW. Does anyone bill for this, and have you been getting paid?