As of 07/01/23 Medicare CCI Edits are bundling codes G0480-G0483 with codes 80305-80307. A modifier is now required on the G codes. Does anyone know which modifier(s) we should use on codes G0480-G0483?
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Wiki Urine Drug Screens
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sylviah
Contributor
nategarland81
New
Hi, I am also trying to get some guidance on this new edit. I bill for a CLIA Lab(81) and these UDTs are our bread and butter. It's my understanding that on Oct. 1 2023 CMS will change the indicator to "1" and that will be retroactive to July 1 2023. Under the right circumstances when both G0480-G0483 and 80305-80307, what would be the appropriate modifier to bypass the edit? We have talked about 91, 59, XE, XU. I am leaning towards 59 and XU but my bosses feel like it could be 91 or XE. I am very new to billing and coding. Please feel free to correct me if I'm wrong. LOL Thanks!!!!
fanninm
New
I am also in need of this information since I also bill for a CLIA Lab. Any help would be appreciated.
sunnypaul
New
Please some one who can guide through situation, Me too needed this Badly
jkyles
True Blue
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Hi there, You might want to rope your lab manager into the conversation on which of the distinct service codes might be appropriate. 91 isn't an option. It indicates you're repeating the exact same test.
kjdallas
Networker
We are using the 59 on the G code
cubuscrystal
Networker
Have you received any payments when using mod 59? If so, which payers?
We have been using 59 on G code and as of right now Aetna and Cigna have been paying for both 80307 and G code.
cubuscrystal
Networker
Thank you! Have you received any denials for other payers with modifier 59? We haven't tried any payers w/mod 59 yet but hoping to try a few next week.
Medicare has been the only insurance so far that has not paid G code with modifier 59. All our other payors have been paying claims without any issue.
cubuscrystal
Networker
MEDICARE WITHDREW THE EDIT!!!!!!!!!!!!!!!! I just received the email
cporras20
New
Did they send a link or pdf?
cubuscrystal
Networker
No link or pdf, I sent them an email when this first happened so they replied to my email with this
Thank you for your inquiry regarding the National Correct Coding Initiative (NCCI) program. The Centers for Medicare & Medicaid Services (CMS) owns the NCCI program and is responsible for all decisions regarding its contents.
CMS considered the concerns raised by the lab industry and decided to withdraw the NCCI PTP edits between Column One codes 80305, 80306, and 80307 for presumptive test(s), and Column Two codes G0480 – G0483, and G0659 for definitive test(s) while CMS continues to study the issue.
CMS will work to operationalize this change in a replacement file for the 4th quarter of 2023 and will apply it retroactively to July 1, 2023. As a result, any claim that was affected by the procedure-to-procedure edits, including those that did not apply an NCCI modifier, will be processed and paid as appropriate under existing payment and coverage policies. CMS will post the replacement file on the NCCI PTP webpage as soon as technically possible.
The NCCI program provides general information to the public regarding the NCCI program and edits. However, we do not provide specific billing or coding advice to providers/suppliers. If the issue you are having applies to other government and private insurers who voluntarily choose to implement NCCI edits, we do not have control over how they apply NCCI edits. Questions regarding specific claims (e.g., specific scenarios) should be addressed to your payor or your claims processing contractor (e.g., your Part A or B Medicare Administrative Contractor (MAC) or State Medicaid Agency). Providers/suppliers may also find it helpful to contact their national healthcare organization or the National Healthcare Organization (NHO) whose members commonly perform the procedure.
We appreciate your participation in the National Correct Coding Initiative (NCCI) edit process.
Sincerely,
The CMS NCCI Program Team
Audits and Vulnerabilities Group
Center for Program Integrity
Centers for Medicare & Medicaid Services
Confidentiality and Restricted Disclosure Notice: This e-mail is intended only for the use of the named addressee(s) and may contain information that is confidential, privileged or regulated under federal and/or state law, including The Privacy Act and HIPAA. If you are not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this e-mail is strictly prohibited. If you have received this e-mail in error, please notify the sender immediately by replying to the e-mail and destroy all copies of the original message. If you are the intended recipient, you are notified that you have the obligation to ensure that any further dissemination, distribution or copying is consistent with applicable law.
cubuscrystal
Networker
Medicare withdrew the edit. I received this email yesterday.
Thank you for your inquiry regarding the National Correct Coding Initiative (NCCI) program. The Centers for Medicare & Medicaid Services (CMS) owns the NCCI program and is responsible for all decisions regarding its contents.
CMS considered the concerns raised by the lab industry and decided to withdraw the NCCI PTP edits between Column One codes 80305, 80306, and 80307 for presumptive test(s), and Column Two codes G0480 – G0483, and G0659 for definitive test(s) while CMS continues to study the issue.
CMS will work to operationalize this change in a replacement file for the 4th quarter of 2023 and will apply it retroactively to July 1, 2023. As a result, any claim that was affected by the procedure-to-procedure edits, including those that did not apply an NCCI modifier, will be processed and paid as appropriate under existing payment and coverage policies. CMS will post the replacement file on the NCCI PTP webpage as soon as technically possible.
The NCCI program provides general information to the public regarding the NCCI program and edits. However, we do not provide specific billing or coding advice to providers/suppliers. If the issue you are having applies to other government and private insurers who voluntarily choose to implement NCCI edits, we do not have control over how they apply NCCI edits. Questions regarding specific claims (e.g., specific scenarios) should be addressed to your payor or your claims processing contractor (e.g., your Part A or B Medicare Administrative Contractor (MAC) or State Medicaid Agency). Providers/suppliers may also find it helpful to contact their national healthcare organization or the National Healthcare Organization (NHO) whose members commonly perform the procedure.
We appreciate your participation in the National Correct Coding Initiative (NCCI) edit process.
Sincerely,
The CMS NCCI Program Team
Audits and Vulnerabilities Group
Center for Program Integrity
Centers for Medicare & Medicaid Services
Confidentiality and Restricted Disclosure Notice: This e-mail is intended only for the use of the named addressee(s) and may contain information that is confidential, privileged or regulated under federal and/or state law, including The Privacy Act and HIPAA. If you are not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this e-mail is strictly prohibited. If you have received this e-mail in error, please notify the sender immediately by replying to the e-mail and destroy all copies of the original message. If you are the intended recipient, you are notified that you have the obligation to ensure that any further dissemination, distribution or copying is consistent with applicable law.