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CPT 80305 NO Modifer til April 1 2017- after April 1 2017 bill w/ QW modifier?

  1. Default CPT 80305 NO Modifer til April 1 2017- after April 1 2017 bill w/ QW modifier?
    Medical Coding Books
    Hello, My question is about Drug Screens. I know Medicare has replaced G0477 with 80305 effective 1/1/2017, but the PDF says its effective date is April 1, 2017. They did the same thing last year when they replaced G0434 with G0477. I do remember that having an effective date of April 1, 2016 (found PDF below) and that is when I had to start adding the QW modifier on April 1, 2016. I have billed Medicare with 80305 and added QW modifer and I am being denied. My real question is Has anyone billed with NO modifer and gotten paid for 80305? I know the modifer will be in place after April 1st, 2017 just not sure if it will still deny or if they will come back and pay them later if I bill it without the Modifier until April 2017. In 2016 I billed G0477 without modifier until April 1 2016 and Medicare paid.

    My denial reason from Medicare when billing 80305 QW: The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

    Effective April 1, 2017 https://www.cms.gov/Outreach-and-Edu...ads/MM9956.pdf
    Effective April 1, 2016 https://www.cms.gov/Outreach-and-Edu...ads/MM9515.pdf

  2. Default 80305 Billing
    Hello All:

    I have billed it both ways and keep getting the same error message as you. If someone has been successful please advise.

  3. Default 80305 Billing
    I have also had 80305 denied both with and without. The same thing happened for me in 2016. They wouldn't pay either way until April.

  4. #4
    Clarksville, TN
    I have also received denials. With modifier -QW it tells me invalid modifier. Without it I get denial B7-provider not certified/eligible to be paid for this procedure; with N570-missing/incomplete/invalid credentialing data. He should be good to bill this code. Hoping somebody comes up with a different answer ::fingers crossed::

  5. Default QW modifier
    I am a bit new to the lab billing field. Can someone help me understand when the QW modifier needs to be applied to a lab?

  6. Default
    Medicare will not be paying this code until 4/1/17.We can resubmitted with QW modifier in the month of April 2017.
    80305-QW will be valid only after April 1/17.
    Last edited by NishaJ; 02-21-2017 at 04:44 AM.

  7. Default
    We are getting the same denial whether we use the QW or not. I talked to a Medicare rep & she said Medicare will not be paying for this code until April 1st. Hope this helps!

  8. Angry
    Well this stinks. I had no trouble with G0477 last year with our Medicare carrier but Palmetto (RR) has already denied my first 80305 this year. The claims at my local carrier are all still pending. This is ridiculous!

  9. Default
    We are still having denials on the G0477's from 2016. We are submitting them with the QW modifier. They deny as procedure code/modifier incorrect? How did you get your G0477's paid in 2016? These codes are only denying in one of our billing offices; there are offices in different towns.

  10. Default 80305
    I'm new to this code as well and my provider is also using 99000 lab handling fee. I did not think that the 99000 should be used also. Please help explain. Thanks,

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