# Urine drug screens



## LyndseyS2013 (Aug 28, 2013)

We are running into problems with United Healthcare not paying for Urine drug screens when using code 80104 with QW modifier.....we most recently changed from the 80101 to the 80104 and are still getting denials on both. I am using V58.69 as the diagnosis code for the UDS, along with other ICD-9 codes for reason for the visit. Anyone have any advice or suggestions as to what we are doing wrong??


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## airart (Sep 2, 2013)

*Lab code denials*

UHC, I think, follows Medicare Guidelines.  Here is an article regarding your topic from AAPC.  Try billing the G code to UHC for payment.

Changes to Tests, CLIA for Medicare
April 5th, 2010

The Centers for Medicare & Medicaid Services (CMS) provides special instructions for the proper use of CPT® codes 80100, 80101, 80101-QW, and HCPCS Level II codes G0430, G0430-QW, G0431, and G0431-QW as of April 1. The instructions impact both the lab fee schedule and list of waived tests.

Effective Jan. 1, two new G codes were established – G0430 Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure and G0431 Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class – as it had come to CMS' attention that some companies were using questionable billing practices concerning CPT® codes 80100 and 80101. The G codes are meant to operate in place of and alongside 80100 Drug screen, qualitative; multiple drug classes chromatographic method, each procedure and 80101 Single drug class method (eg, immunoassay, enzyme assay), each drug class.

Clinical laboratories requiring a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver had been utilizing 80101-QW. Effective April 1, however, clinical laboratories requiring a CLIA certificate of waiver should use G0430-QW  and G0431-QW to bill correctly, whether the performed drug screen test is for a single drug class or multiple drug classes. The modifier QW CLIA waived test should be appended to codes used for CLIA waived tests.

For purposes of the Clinical Laboratory Fee Schedule (CLFS), beginning April 1, when performing a qualitative drug screening test for multiple drug classes that use chromatographic methods, 80100 is the appropriate code to bill. New test code G0430 was created to limit the billing to one time per procedure and to remove the method's (chromatographic) limitation when it's not used in the performance of the test. As a result, when a clinical laboratory not requiring a CLIA certificate of waiver performs a qualitative drug screening test for multiple drug classes not using chromatographic methods, new test code G0430 is the appropriate code to bill. When a clinical laboratory requiring a CLIA certificate of waiver performs a qualitative drug screening test for multiple drug classes not using chromatographic methods, G0430-QW is the appropriate code to bill. New test code G0431 is a direct replacement for 80101. For purposes of the CLFS, beginning April 1, new test code G0431 should be utilized by those clinical laboratories that do not require a CLIA certificate of waiver. Clinical laboratories requiring a CLIA certificate of waiver should utilize new test code G0431-QW.

Effective April 1, code 80101 will no longer be covered by Medicare, and code 80101-QW will be deleted.

http://box675.bluehost.com/~aapccom/news/index.php/2010/04/changes-to-tests-clia-for-medicare/


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## suemt (Nov 7, 2013)

Here is a link to UHC's September 2013 Network Bulletin that describes (on page 27) how they will change to use the G codes for drug screen testing effective 2014.  

https://www.unitedhealthcareonline....sPdf/News/September_2013_Network_Bulletin.pdf

So I'm not sure if this means they currently accept both the 8010x codes and the G043x codes, or if they currently only accept the 8010x codes.


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## KelliJones (Nov 18, 2013)

We are also having an issue with the 80101 I spoke to a United Healthcare rep and they told me that you have to use the G0434, however we are now getting denials for that as well.  We were billing 80101 at 9 units.  Any suggestions??


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## KMCFADYEN (Mar 3, 2015)

We are billing G0434 QW and are not having any problems with reimbursement


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## Cleanslate15 (Mar 5, 2015)

*Urine Drug Screens*

We have been following the Medicare coding and using the G043x when appropriate. And ultimately, for me, all of my carriers have switched over to the G code as well with no issues in reimbursement. With the exception of any frequency limitations.


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## suemt (Mar 5, 2015)

Cleanslate15 said:


> We have been following the Medicare coding and using the G043x when appropriate. And ultimately, for me, all of my carriers have switched over to the G code as well with no issues in reimbursement. With the exception of any frequency limitations.



What have you been doing about the frequency limitations?  What are you finding are the limitations?  Do they vary by carrier?  Carrier/plan?  Sometimes it seems there is no rhyme or reason to the frequency limitations.


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