• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We’re introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

Billing FL Medicaid for drug screen done in office

skweston

Contributor
Messages
14
Location
Brandon, FL
Best answers
0
I do billing for a pain management doctor. We regularly perform drug screens with a multiplexed drug testing kit, We bill G0434 QW to all payers. Fl Medicaid is the only payer that does not have this code on their fee schedule.

Does anyone know the process, if any of getting the state to review the revised/new CPT codes so that they might possibly be added to their fee schedule.

Sending our Medicaid patients to an outside lab or charging them outright is our only option at this time (albeit not a desirable one) If anyone has any suggestions or ideas to help would be appreciated. Also 80104 is not on their fee schedule either.
 

blazeunreal

Networker
Messages
25
Best answers
0
Up until this year we have always billed Medicaid 80101 and most other payers G0434 QW. Now we get denied as CLIA LICENSE -PROCEDURE MISMATCH. When I call Medicaid they direct me to CMS.org/clia and they say there is somewhere on here that will match our license to a code, however I have been unable to find anything remotely close to this.

Have you found anything out on this? Or does anyone know?
 

skweston

Contributor
Messages
14
Location
Brandon, FL
Best answers
0
80101 is considered a test of moderate to high complexity.. since we only have a CLIA certificate of waiver we technically cannot bill that code anywhere. G0434 is a CLIA waived test which is what we bill to all payers, Medicaid however does not have this code on their fee schedule, therefore it is not payable. The only CLIA waived urine drug test that I can see on the cms.gov/clia website they directed you to is G0434-QW.. but that doesn't help when FL Medicaid doesn't recognize that code.

We do qualitative analysis by multiplexed screening kit for multiple drugs or drug classes and send the results to an outside lab for confirmation this is most closely matched to the 80104 code, G0434 is the HCPCS equivalent of 80104 but again FL Medicaid does not have either of those codes on their fee schedule and I was told that it would take an act of Congress to get the State to update their fee schedule to reflect the updated codes that were put forth by CMS several years ago.

I have no idea what the correct course of action would be here. We are required by law to do monthly drug screens on our patients to make sure they are in compliance with pain management and sometimes it is not feasible to send the patient to say LabCorp or Quest when its harder to catch non compliance if we send them to an outside lab... in my opinion.
 
Messages
2
Best answers
0
APT new coder

That's one that I'm encountering right now, since 80104 its not on fee schedule, I don't know what is the appropriate charge for 80104, I deal with Dept. of Labor insurance and I tried billing it for $250 and got paid for the exact amount. So, I'm just wondering if this is the right way to do it.

Thanks:
 
Messages
2
Best answers
0
APT new coder

Do you need to be a CLIA licensed for you to use 80104 for a office setting.

Need help pls. Thanks
 

skweston

Contributor
Messages
14
Location
Brandon, FL
Best answers
0
Top