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G0434

  1. Default G0434
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    Hi everyone!

    I billed a G0434 to Medicare on a Skilled nursing pt. I noticed that the 99203-25 code was pd but not the G0434. I was wondering if I needed to place a modifier on the G code in order for it to pay? Does anybody know?

  2. Default
    This is from the most recent MLN Number: SE1105


    G0434 includes qualitative drug screen tests that are waived under CLIA as well as dipsticks, cups, cards, cassettes, etc, that are not CLIA waived.

    Laboratories with a CLIA certificate of waiver may perform only those tests cleared by the Food and Drug Administration (FDA) as waived tests. Laboratories with a CLIA certificate of waiver shall bill using the QW modifier.

    Laboratories with a CLIA certificate of compliance or accreditation may perform non-waived tests. Laboratories with a CLIA certificate of compliance or accreditation do not append the QW modifier to claim lines.

    Only one unit of service for code G0434 can be billed per patient encounter regardless of the number of drug classes tested and irrespective of the use or presence of the QW modifier on claim lines.

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