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Thread: 80101 vs G0431 - I work with several pain management

  1. #11
    Join Date
    Apr 2007
    St. Joseph County, Indiana


    AAPC: Back to School
    Interesting. Noridian MAC is DME (?) which may pay 80/20.

    If you are a physician's office, the claims for drug tests should go to your Part B carrier. They pay them at 100%


  2. #12


    Noridian is the Part B carrier. I've asked them, but no reply yet.

  3. #13


    I have questions specifically about using CPT code G0431 in 2010. I was directed to the NCCI office by our local carrier (WPS) and they have sent me information stating that offices who were testing using strips should not have been billing G0431 because that code in 2010 described high complexity testing and cups or strips are moderate complexity.

    My questions:

    1. If each strip tests for a particular drug class and we were performing up to 13 classes or "dips" on each urine sample in 2010....how can this be billed using a CPT code whose descriptor states "multiple drug class methods?" G0430 states "mulitple drug classes" but our NCCI contact states this should be used for moderate (cup & strip) coding in 2010.

    2. The salesman provided us with information that stated the description of "each procedure" meant for each dip...who would expect any less from a salesman?? However, the contact person has indicated that it should be billed only once per specimen, regardless of the # of dips.

    I would appreciate any clarification that you may have on these two issues. It's really too bad that Medicare is so vague and un-responsive sometimes!! Keep it a secret...but expect it to be done correctly at the same time.

  4. #14


    For 2010:
    G0430 – Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure
    G0431 – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class
    Technically if an office was using a multi-class strip/cup then G0430 was to be used and billed once @ 1 unit. If they were using individual strips the G0431 was being used times however many classes (units) were tested at the point of care. This was also used if an analyzer was utilized.
    Due to this overutilization of the G0431, at times inaccurately, CMS restructured the codes for UDS for 2011.
    Most people believe the G0431 was originally meant for the high complexity testing when it was introduced in 2010, however because of the vague verbage it didn't clearly read that way.
    CMS definitely made sure there was no doubt in anyones mind come 2011 that G0431 was, and is, for high complexity only now as of 1/1/11.

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