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G0431

vpaceley

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Has anyone billed for this procedure code for drug testing? Trailblazers's website says they will pay per unit but they are only paying for 4 and we are performing 12.
 
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Coastal Coders
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I'm having the same problems with G0431. Looks like they have a limit of 4 now which I do not understand. I decided to do an appeal based on the fact that we provided 8 seperate responses to the test. Our appeal was denied and the Medicare adjusted the units to 1. "For HCPCS code G0431, only one test per episode of care will be allowed because Palmetto GBA does not consider multiple individual tests to be medically necessary when a single testing item to screen for all drug classes is available" I still do not understand and I have contacted Medicare and they cannot explain in any additional detail. Someone is supposed to call me back. Any idea on the proper use of this code would be appreciated. Why was a limit of 4 put into place on 07/01/2010? Why is the appeal making the units billed 1? Is 1 unit correct because we are getting a response from one machine as to the drugs found in the specimen. My understanding is that several cards are place in a machine and it gives several results. Whatever help can be given on this code would be appreciated as it is obvious that several people are experiencing the same problems.
 
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