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Urine drug screen in office

biller007

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I need some help in regards to Urine Drug Screens in the office. Medicare changed the 80101 to a G0434 in 2011, stating billible 1 per encounter. BCBS states bill per drug class, which there are 6-10 drug classes, which would tell you to quantify the 80101. These physicians are paying less than $5.00 per UDS, Medicare is paying $12.54 for 1 per encounter. (which makes sense to me), but if we bill BCBS for a quantity of 10 (1 for each drug class) they will pay us $121.20. I am trying to tell BCBS they are OVERPAYING for this service now as to avoid doing million dollar refunds in the future. No one can help me, the code in the CPT manual states per drug class as well. The EXACT same UDS is being used for Medicare pt's as BCBS pt's. Isnt there an issue here??? I would appreciate any help with this, I have been all over the internet and the AAPC website, it seems that I am not the only one confused here. Please advise as how I should proceed. I somehow cannot wrap myself around billing one insurance 25.00 and the other 200.00 for the same thing. Thanks in advance for any help you may offer. I have email coorespondance from BCBS as well. Amber Logan, CPC, CMC
 
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ralmero

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urine drug screen in office

You are absolutely correct by billing only 1 unit for the G- code in compliance with CMS CY2011:

"CMS created this new test code based on a programmatic need to accurately reflect both CLIA waived and moderate complexity testing for drugs of abuse per patient encounter rather than per dipstick test. As a result, CMS also recommends changing the descriptor to more accurately reflect this goal. This reflects the fact that in any given patient encounter, no matter how many drugs of abuse tests are performed and no matter whether these tests are CLIA waived (simple dipstick test kit) or moderate complexity (reader outside the laboratory setting), proper billing would be one time per patient."

Currently, Medicare no longer pays for the 80101 code.
 
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bschulte1973

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I have recently done some research on billing drug screens and this is what I determined.

The 80101 which is for a quantative single class crosses over to G0431 for Medicare. You can only bill one unit to Medicare, however, the reimbursement amount from Medicare indicates that CMS is aware the test will be done for more than just one unit. This code should be billed when your result indicates positive or negative result and amount of drugs in system.

The 80104 which is for a qualative multiple drug class result crosses over to G0434. This code is only billable for one unit on the 80104 as well as the G0434. This code should be billed when you perform a multiplex screening kit, urine cup, test cards, or test strips.


Hope this helps, :)
 

pgarcia1

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I have recently been discussing 80101,80104, and G0434 with Quest our supplier for testing. Am I to understand:
1. If you use a multi- test cup use 80104-with a 1 in quanity.
2. If you use the dip-stick method use 80101- with up to 10 in quanity depending on tests.
3. Always use G0434 for Medicare - with only one in quanity.

Also is it correct that the QW modifier is nolonger being used.

I have been searching for answers on these questions...can anyone help me.
 
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