# drug testing and getting paid by medicare and medicaid for G0478 Drug test



## seanaenae (Feb 24, 2016)

G0478 Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service 

im using this code with a QW MODIFIER AND DX CODE Z79.899
its not getting paid by the insurance does anyone know if this code is reimbursable.


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## CodingKing (Feb 24, 2016)

It is a CLIA waived test retro to 1/1/16 However the Medicare implementation date is not until 4/1/16


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## Walker22 (Feb 24, 2016)

That is going to vary by payer, so there is no way to answer your question. What is the denial reason that they are giving for not reimbursing the code?


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## seanaenae (Feb 24, 2016)

The denial is saying not covered by payor or not reimbursable under policy. My provider wants to give the drug test but i dont think its covered.... Medicaid stated that it was covered under them if the patient was medi medi.


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## seanaenae (Feb 24, 2016)

We have had patients sign an abn and then drop the charge to the patient after its denied... I really dont see the medical neccesity for the test. Unless the doctor really feels it is.


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## seanaenae (Feb 24, 2016)

Im trying to verify that the code i am using it correct and the dx is correct. And i am trying to see if medicare pays this code.... True blue is that 4/ 2015  or did you mean 4/2016? Can you explain more please im interested on what those dates mean. Thank you


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## CodingKing (Feb 24, 2016)

Sorry meant effective 4/4/16 for dates of service 4/1/16 and forward. Im still confused about the date, header says eff 4/1/16 but the body seems to indicate retro to 1/1/16. Also looks like its G0477 that is included which is optical only no instrument. G0487 or higher needs a CLIA certificate

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/Downloads/MM9515.pdf


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## seanaenae (Feb 24, 2016)

So go477 may be the code i should use ? The 2016 hcpcs doesnt even have the new codes where can i find them ?


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