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Thread: Medicare G0431 - Medicare is denying G0431 stating

  1. #1

    Default Medicare G0431 - Medicare is denying G0431 stating

    AAPC: Back to School
    Medicare is denying G0431 stating " The number of days or Units of service exceeds our acceptable maximum". We billed 12 units and Medicare says that we can only bill a max of 9 units effective 04/01/10. I can't find any information about the number of units allowed with G0431. Anybody have anything?
    Last edited by ank3t; 10-05-2016 at 07:23 AM.

  2. #2
    Join Date
    Apr 2007
    Central Dallas, Texas


    We typically bill 8 units of G0431 so we haven't received denials. I am, however, receiving an MUE edit for Tricare (Champus) allowing only 4 units of G0431. I can't find anything regarding the limit for Medicare or Tricare. Sorry. Hope someone can help us.

  3. #3


    I have had the same problem with Medicare denying the G0431 for # of units, I bill 11 units and Medicare will not tell me how many is the max they will pay. they said more than one but less than 11, we had no problems with the
    previous code 80101, does anyone know for sure what the maximum payable is?

  4. #4
    Join Date
    Apr 2007

    Default G0431

    Can we continue to use G0431 for UA drug screening? or does it need to be done only with an expensive table top lab spinner?

  5. #5

    Smile Robin CPC

    Just got off the phone with Medicare with the same G0431 QW problem. Per "Natasha" for 11 units bill
    G0431 QW - 9 units (this is the max that they won't tell you)
    G0431 QW,59 modifier - 2 units
    Hope this helps

  6. #6

    Default G0431qw

    We have found out that Medicare is denying 5 units as of July 1st, and we can only bill a max of 4 units.

    Has anyone else come cross this problem.

  7. #7
    Join Date
    Apr 2007

    Default Medicare G0431

    I was just denied for billing 9 units. I was told as of July 1st the # of units decreased but the customer service rep was unable to tell we what the correct number is. He did say that what I was billing was more than double what is allowed. He also said, that there is no where to find the correct # as it is not published and that providers need to keep billing until they get the correct number.

  8. #8

    Default G0431

    We are Pain Management Practice and perform RDS as 11 drugs and total 9 drug classes.

    I am billing G0431-QW 9 units.

    Effective 07/01/2010 Medicare started denying claims with CO-151: Payment adjusted because the payer deems the information submitted does not support this many services. I spoke to Medicare (we are in Texas) and neither level one non two representative was able to provide reasonable explanations. The issue was sent to level three and it will take about 30 business days to get a response. I did not find any information (limitations) regarding number of units on MUE or on websites.

    I will appreciate any thoughts and comments regarding this issue.


    Yulia Miller

  9. #9
    Join Date
    Apr 2007
    North Carolina


    CMS is aware that some providers were/are submitting the units incorrectly. They are somewhat reserved on providing how many units are allowed. Recently, I sat in on a Medicare teleconference and this subject was brought up by a practice. The caller indicated that they were instructed, by a outside rep, how many units to bill. Needless to say, our Medicare director was less than impressed with the information provided and went on to say that he would like the name and number of this business because he would like for someone to pay them a visit. With that said, below is a link of FAQ addressed by CMS. It provides some information but it still leaves some unanswered questions.

    Under downloads, click on "clinical laboratory FAQ's"...


  10. #10

    Default G0431

    I bill for a billing firm we have over 150 providers 3 of them are using G0431 times 12 units after alot of work I finally got all 12 units paid you can only bill 4 units per line on 3 lines.

    G0431 QW X 4 UNITS
    G0431 QW 59 X 4 UNITS
    G0431 QW 59 X 4 UNITS


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