Wiki Code for Drug Screen

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It depends on the payer as well, some follow Medicare with the G codes and some don't. CLIA waiver is not set up yet on the new G codes so you may have issues getting reimbursed.
 
Can we charge patients for code G0477 if insurance will not reimburse

I work for a pain management doctor. We have had a difficult time getting code G0477 reimbursed by all of the insurance companies. I read somewhere that Medicare was not paying this code until 4/1/16. We have not received any reimbursement from Medicare or commercial insurance companies at all this year. My doctor would like to start charging the patients a fee of $15.00 - $20.00 per collection because we have to fill out the recs and we are not being reimbursed for our time. Is this legal?

Thank you,

DDenson
 
debbie.denson74 said:
I work for a pain management doctor. We have had a difficult time getting code G0477 reimbursed by all of the insurance companies. I read somewhere that Medicare was not paying this code until 4/1/16. We have not received any reimbursement from Medicare or commercial insurance companies at all this year. My doctor would like to start charging the patients a fee of $15.00 - $20.00 per collection because we have to fill out the recs and we are not being reimbursed for our time. Is this legal?

Thank you,

DDenson
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No. If the patient has Medicare, you MUST bill Medicare and appeal any denials.
 
G0431

This is also a situation that I am having some trouble with, and I wondered if you might recognize what I am seeing. The same provider has some claims using just G0431 and an E/M code. Other claims - same provider - have G0431 and the individual assay codes. Additionally, on claims where the individual assays are coded, some assays are billed twice, with mod-91. Does this sound familiar/appropriate?

Thanks.
 
JasmineF said:
This is also a situation that I am having some trouble with, and I wondered if you might recognize what I am seeing. The same provider has some claims using just G0431 and an E/M code. Other claims - same provider - have G0431 and the individual assay codes. Additionally, on claims where the individual assays are coded, some assays are billed twice, with mod-91. Does this sound familiar/appropriate?

Thanks.
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Without having access to the test results and a list of codes that were billed, it's hard to say if it is correct or not. In general, multiple billing of the same code on the same DOS does not seem to be compliant, but again, without the particulars I can't say for sure.
 
Update

Thanks for responding. In this scenario it actually turned out to be appropriate, as they were reporting for each opiate metabolite, using modifier 91.
 
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