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80101 vs G0431 - reimbursable as G0431

  1. #1
    Default 80101 vs G0431 - reimbursable as G0431
    Medical Coding Books
    Is 80101 reimbursable as G0431 and, if so, do we need to submit a CLIA waiver? How do we document complexity for reimbursement?

  2. #2
    Default
    The difference in G0431 and 80101 is the following:

    You can only bill G0431 to Medicare for reimbursement of the drug screen.
    You will bill commercial insurance 80101 for reimbursement of the drug screen.

    Also,
    In your question, you asked how to document the complexity for reimbursement. If you familiarize yourself with the code description, it states that it is "high complexity test method". Therefore, you will receive the reimbursement of the complexity.

    Hope this helps
    Amy Pritchett,
    BSHA, CPC, CPMA, CPC-I, CDEO, CANPC, CEDC, CASCC, CRC, CMDP, CMPM, CCS, CMRS, C-AHI, ICDCT-CM, ICDCT-PCS
    2017-2018 Secretary of Local Mobile AAPC Chapter
    2015-2016 President of Local Mobile AAPC Chapter

  3. Default 80104 payment
    Our practice is looking to utilize the 12 panel urine drug test (80104).... I am curious before we order these if they are being reimbursed. In addition, will they pay with just a V221 diagnosis code ?

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