Wiki 80101

[TMB1965]

I just started working in Neurology Billing, so if 99214-25, and 80101 are being billed together wouldn't I need modifier QW with the 80101 for commercial payers, and for Medicare bill the G0431-QW with the 99214-25? Any help would be greatly appreciated!

 

[marvelh]

The G0431 code is for high-complexity testing, not CLIA-waived. You need to check what type of testing is being performed a CLIA-waived cup or dipsticks or a high complexity immunoassay analyzer.

In addition, if you are using a CLIA waived test, more than likely the code you would use for 2014 dates of service would be 80104 and 80300 for 2015 dates fo service.

Most commercial payers do not require the QW modifier but also don't deny the claim with the informational modifier reported on the line item. However, Medicare does require use of the QW modifier with the G0434 code if the lab is only credentialed to perform CLIA waived tests.

 

[TMB1965]

Isn't it also true that most of the commercial payers in 2014 want you to bill the G code instead of the 80101?

 

[marvelh]

In 2014, Aetna, Cigna, United HealthCare and many of the state BCBS and Medicaid plans used the G0431 & G0434 codes.

If a CLIA waived test cup, dipstick, cassette was used, you would bill G0434-QW with 1 unit of service on a single line item. The G0431 code is for high complexity drug testing, not CLIA waived.