Wiki G6058 vs 84999

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rbordes

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I am having a problem getting clarification on the correct code to bill to Medicare for the new 80000 series crosswalk codes. We bill Drug Classes and I have a select set that have been crosswalked to the G6058, i.e. Amphetamines New CPT 80324 crosswalked to G6058, but Medicare is not accepting the G6058 and we then changed to 84999, and that is not acceptable either.
1.) Am I crosswalking correctly?
2.) If crosswalked correctly, is this a code that Medicare is just not going to accept?

Please educate me, Thank you in advance for any help/education you can provide!
 
I do apologize Amphetamine was a bad example...
However I have done a little more research and the cpt's I am having trouble cross walking for Medicare are:
80338
80332
80342
80349
80350
80355
80357
80359
80360
80366
80368
80371
80335

and if there are no crosswalks does that mean Medicare does not cover these services?

Are there any resources for education regarding Clinical Laboratory Billing?
 
Have you read through the LCD for your Medicare carrier? They usually list the codes they will accept. Here in Georgia, based upon our LCD, I would replace many of those codes with 83789.
 
Laboratory Toxicology

I have a question. We are opening a lab and I want to make sure I am billing this correctly. If test is ordered for Benzodiazepines and they have checked lets just say 5 listed under that heading. Would you bill 80346X5 for commercial and G6031X5 for Medicare. TIA
 
tolbert4 said:
I have a question. We are opening a lab and I want to make sure I am billing this correctly. If test is ordered for Benzodiazepines and they have checked lets just say 5 listed under that heading. Would you bill 80346X5 for commercial and G6031X5 for Medicare. TIA
Click to expand...

No, sorry, that is incorrect. You bill one unit of 80346 for any amount of Benzo analytes up to 12. You would bill one unit of 80347 for any number of Benzo analytes 13 or more. Metabolites are not counted separately from the primary drug.

As far as G6031 is concerned, you would bill one unit no matter how may Benzo analytes are tested.
 
niecey38 said:
Walker do you replace codes using 83789 for GA MEDICAID?
Click to expand...

Georgia Medicaid has added some of the 803xx series to their fee schedule but not all. For the ones they haven't added, it is unclear what code should be used. Normally you would not substitute 83789 for any of the 803xx codes because the 803xx codes are more specific. In this case, however, using 83789 seems to be a credible alternative. Having said that, I would never suggest replacing a more specific code with a less specific one without guidance from the payer first. You may want to call them for clarification. It may just turn out that you cannot get paid for the codes they have neglected to add. A sorry state of affairs, but that's Medicaid for you.
 
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