Billing for Presumtive read multi class drug test cups


Douglas, WY
Best answers

We have found some confusion regarding how to bill these tests. Prior to 2016 we were billing G0434 with QW modifier appended for CLIA waiver. Last year we went to the G0477 with a QW modifier. We are now getting claim errors with our clearing house on the G0477 code stating it is no longer a valid code. Looking at the CMS website our Medicare biller found that this code was listed as discontinued as of 01/01/2017. Also when I checked the Optum Encoder 360 it says the same, but the 2017 HCPCS book still lists this as a valid code. In researching we found the new 80305 CPT but is this the proper replacement code and would it be appropriate to append the QW modifier to it if so. This is for a drug screening cup that we use in our medical clinic on our pain contract patients among others and we do have personnel that are properly CLIA certified. We are kind of in a holding pattern until we figure out what is correct. Does anyone have some guidance on this matter?