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UDS - Still confused! Help

  1. #1
    Lightbulb UDS - Still confused! Help
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    Hello Everyone!

    I have read and read and read everything I can on Urine Drug Screening and I am still totally confused. I recently took over a Pain Management office and need help. Currently it looks like they have tons of UDS in their A/R unpaid.

    Medicare changed the code on us this year to now bill G0430 for checking for multiple classes but we can only bill with 1 unit now and get around 17.00? Even if we check for 7 classes?

    We need to use the V codes to get paid with it?

    We need to use the QW modifier?

    We need to put our clia waiver number in box 23 and in box 19 (or its electronic equivalent)? Or do we even need to bother with this step?

    Does anyone know if 80101 (I think that is what the code was before the change) is getting paid by anyone?

    Thanks in advance!

  2. #2
    Default Uds
    Medicare has not been clear on the units billed but a Medicare rep let it slip to me that only 4 units are billable after 7/1/10 and only 9 units prior to this date. the CLIA modifier depends on if your lab is CLIA certified or not, I would check with your Lab on this. I hopes this helps

  3. #3
    Default Uds
    oh! I forgot 80101 is no longer billable to Medicare.

  4. #4
    Thanks! We have a CLIA Waiver. Does that matter?

    Sorry I have never dealt with CLIA's before.

  5. #5
    Yes, then you bill G0431 with the QW modifier and put your CLIA waiver number in the electronic equivilent of box 23 of the CMS1500 form. I don't remember what loop that is for electronic claims, but your software vender should be able to help with that.
    Walker Bachman, CPC, CPPM

  6. #6
    G0430 QW with one unit---2 panel to 11 panel CLIA waived test Accept the current reimbursement or set up to have the lab provide a blank cup and they do the billing and forgo the initial field test you get with a panel cup.

  7. #7
    Make sure you are differentiating between g0430 and g0431. The difference is how it's tested.
    G0430 uses chromatography and checks multiple classes - each procedure-meaning you get one.
    G0431 is by immunoassay, enzyme assay and checks single drug class-each drug class tested-meaning you get however many you are testing.
    this is where the units billable per line item mentioned earlier comes in. No more than 4 per line. So, if you are testing 6 different drug classes by immunoassay:
    g0431qw x 4
    g0431qw x 2

    If you are testing 6 different drug classes by chromatography:
    g0430qw x 1

    this is my interpretation only. If anyone else has a different view, would love to hear it. This is confusing for everyone and we are getting no help from medicare on this. We have asked whether they are referring to actual drug classes (of which I think there are 6) or whether they are referring to actual drugs (which we test around 10 or 11). Can't get an answer. But like above we have found you can bill 4 per line.

    Hope this helps and doesn't throw more confusion out there. If anyone else can help simplify this, would love to know.
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  8. #8
    Look at the descriptor for G0430 it says OTHER THAN CHROMOGRAPHY. If you go to the MLN Matters link on drug testing and look at the type of drug test kits that go with which codes you will see that G0431 has test that only test one drug class and that is it. If you look at the drug test kits for G0430 these are multiple panel tests.

    There is no way around the current reimbursement. It is not compliant to use G0431 and bill multiple units with multiple panel drug test kit.

  9. #9
    I stand corrected on G0430, thanks.
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

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