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Thread: G0431 mues

  1. #1

    Default G0431 mues

    AAPC: Back to School
    I work at a doctors office and we have an in house lab. We had been billing g0431 x9 and g0431 x3 with a 59. This had been paid up until july 1, 2010. The mues are updated each quarter, but the mue amount for this cpt code is still confidential. Dose anyone know what the new max is or a better way for us to code g0431? Also medicare just loaded mod 91 to their system, should we be using this mod instead of 59? Thnaks

  2. #2
    Join Date
    Apr 2007
    North Carolina


    This code confuses me. I'm getting all types of mixed answers regarding the units. Our most recent Medicare ACT provided this answer...Of course, this stirred up even more confusion..

    NC/ ID Ask-the-Contractor Teleconference (ACT)
    June 24, 2010

    Q: What is the maximum number of units billable for HCPCS code G0431, qualitative drug screen test?

    A: This code is subject to a Medically Unlikely Edit (MUE). This code is intended for use with the dipstick test which has 8-10 qualitative findings on it. It is essentially one test, thus one unit of service, regardless of the number of drugs it is testing.

  3. #3
    Join Date
    Apr 2007
    Kokomo, IN


    Your right that is confusing. We also were using 9 until July 1. Then we were told no more than 4. 5 will not pay. So, we changed the way we are doing for no more than 4 per line item. We'll see how long this (or if it even will) works. I think this is one that will need clarification in 2011 (hopefully)
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

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