LynneC1
Contributor
- Messages
- 11
- Location
- Vero Beach, FL
Hello,
I am reaching out for coding advice on Cigna's reimbursement policy for definitive drug testing. We are a Florida-based pain management office.
I understand the update indicating that G0480 is the only reimbursable HCPCS code. However, my providers are conducting their testing based on medical necessity, which results in some cases more than 7 drug classes being reported. In reviewing some of the G0481 EOBs, there is a carrier indication stating that 'This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted (N572)' and 'This non-payable code is required reporting only (C0246)'. Does anyone have insight into this carrier verbiage?
Thinking it through, I understand that if it's figured out, Cigna would at least split the claim and reimburse G0480.
Your assistance would be appreciated.
I am reaching out for coding advice on Cigna's reimbursement policy for definitive drug testing. We are a Florida-based pain management office.
I understand the update indicating that G0480 is the only reimbursable HCPCS code. However, my providers are conducting their testing based on medical necessity, which results in some cases more than 7 drug classes being reported. In reviewing some of the G0481 EOBs, there is a carrier indication stating that 'This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted (N572)' and 'This non-payable code is required reporting only (C0246)'. Does anyone have insight into this carrier verbiage?
Thinking it through, I understand that if it's figured out, Cigna would at least split the claim and reimburse G0480.
Your assistance would be appreciated.