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Medicaid and G0461

  1. #1
    Default Medicaid and G0461
    Medical Coding Books
    Has anyone had trouble getting Medicaid to pay for more than 1 unit of G0461 per day? They state they only pay 1 per day regardless but we sometimes bill multiple specimens per day therefore use G0461 more than once. How do you get around that? They do not acknowledge modifier 59. I know they instruct us to append a 77 modifier for repeat procedures. I disagree with them that this would constitute a "repeat procedure" but rather a procedure done once on multiple specimens. Any one have any ideas? An appeal never results in a favorable decision with Medicaid. We are in NJ. Even the add on code G0462 would not apply.

  2. #2
    Montrose, CO
    Colorado Medicaid does not recognize G0461, G0462, G0416. As we are coding our charges before billing them out we have to convert those codes to 88342 for G0461 & G0462 and to 88305 x 12 units for G0416. We only bill the professional component and the hospital required that the G codes be used exclusively. If the 88342 bundles with another code such as 88361 (this code always comes in after the original claim went out) we add the 59 modifier but usually we get to appeal and send the reports. We keep a running list of the insurances that recognize the G codes and those who don't. Tricare didn't at first and then they switched and quit recognizing 88342. It put several of our claims in limbo and we had to go back, adjust and re-enter.

  3. Default G0461 and modifier 76
    Billing each G0461 on separate line items and adding modifier 76 to each the
    2nd, 3rd is how we get paid on our claims. G0462 is billed with multiple units if more than 1 is performed.

  4. Default Medicaid 2nd to Medicare G0461 and G0462
    Georgia Medicaid does not recognize G0461 or G0462 and so we have never received Medicaid payment on crossover claims since we bill G does to Medicare. If I change the G code to the 88342 on a hardcopy crossover claim, wouldn't Medicaid deny because the CPT code would not match the HCPC code on the EOMB? How do you get around this issue? Can it be done by electronically adjusting claim on the Medicaid web portal after the line item on the claim is initially denied? I may try one to see and let you know if it works. I would appreciate any feedback from anyone with same issue. Thanks.

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