# Medicare G0431 - Medicare is denying G0431 stating



## CVARGAS

Medicare is denying G0431 stating " The number of days or Units of service exceeds our acceptable maximum". We billed 12 units and Medicare says that we can only bill a max of 9 units effective  04/01/10. I can't find any information about the number of units allowed with G0431. Anybody have anything?


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## CJPoth

We typically bill 8 units of G0431 so we haven't received denials.  I am, however, receiving an MUE edit for Tricare (Champus) allowing only 4 units of G0431.  I can't find anything regarding the limit for Medicare or Tricare.  Sorry.  Hope someone can help us.


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## mistinepowers

I have had the same problem with Medicare denying the G0431 for # of units, I bill 11 units and Medicare will not tell me how many is the max they will pay.  they said more than one but less than 11, we had no problems with the
previous code 80101, does anyone know for sure what the maximum payable is?


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## rosemary14

*G0431*

Can we continue to use G0431 for UA drug screening? or does it need to be done only with an expensive table top lab spinner?
Thanks


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## robreed840

*Robin CPC*

Just got off the phone with Medicare with the same G0431 QW problem. Per "Natasha" for 11 units bill
G0431 QW - 9 units (this is the max that they won't tell you)
G0431 QW,59 modifier  - 2 units 
Hope this helps


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## jholloway2

*G0431qw*

We have found out that Medicare is denying 5 units as of July 1st, and we can only bill a max of 4 units.  

Has anyone else come cross this problem.


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## ValerieDUP!

*Medicare G0431*

I was just denied for billing 9 units. I was told as of July 1st the # of units decreased but the customer service rep was unable to tell we what the correct number is. He did say that what I was billing was more than double what is allowed. He also said, that there is no where to find the correct # as it is not published and that providers need to keep billing until they get the correct number.


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## yulianikmiller@hotmail.com

*G0431*

We are Pain Management Practice and perform RDS as 11 drugs and total 9 drug classes.  

I am billing G0431-QW 9 units. 

Effective 07/01/2010 Medicare started denying claims with CO-151: Payment adjusted because the payer deems the information submitted does not support this many services.  I spoke to Medicare (we are in Texas) and neither level one non two representative was able to provide reasonable explanations.  The issue was sent to level three and it will take about 30 business days to get a response.  I did not find any information (limitations) regarding number of units on MUE or on websites. 

I will appreciate any thoughts and comments regarding this issue. 

Sincerely, 

Yulia Miller


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## RebeccaWoodward*

CMS is aware that some providers were/are submitting the units incorrectly.  They are somewhat reserved on providing how many units are allowed.  Recently, I sat in on a Medicare teleconference and this subject was brought up by a practice.  The caller indicated that they were instructed, by a outside rep, how many units to bill.  Needless to say, our Medicare director was less than impressed with the information provided and went on to say that he would like the name and number of this business because he would like for someone to pay them a visit.  With that said, below is a link of FAQ addressed by CMS.  It provides some information but it still leaves some unanswered questions.

Under downloads, click on "clinical laboratory FAQ's"...

http://www.cms.gov/ClinicalLabFeeSched/


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## jcnwv2

*G0431*

I bill for a billing firm we have over 150 providers 3 of them are using G0431 times 12 units after alot of work I finally got all 12 units paid you can only bill 4 units per line on 3 lines.

G0431 QW  X 4 UNITS
G0431 QW 59 X 4 UNITS
G0431 QW 59 X 4 UNITS

i RECEIVED PAYMENTS ON ALL 12 UNITS. HOPE THIS HELPS.


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## yulianikmiller@hotmail.com

Which state are you in? 

Yulia Miller


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## rajan_cts

*? No duplicate rejections*

Did you received any rejection saying "duplicate" for using G0431-QW-59*4 twice. Kindly confirm


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## spotts

I think this is the only way we havent tried posting the units but will see if it works - 
Thanks for the suggestion


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## LuluBarr

This has changed again? I can't find any official statements of this, but I am hearing that you can only bill one unit of G0431QW?? Has anyone else heard this. I was getting paid for the three lines last year, but now we are getting denials.


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## RebeccaWoodward*

LuluBarr said:


> This has changed again? I can't find any official statements of this, but I am hearing that you can only bill one unit of G0431QW?? Has anyone else heard this. I was getting paid for the three lines last year, but now we are getting denials.



*G0431 may only be reported once per patient encounter.*

Page 3

http://www.cms.gov/MLNMattersArticles/Downloads/SE1105.pdf


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## LuluBarr

Thank you!


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## LuluBarr

UGH! Is modifier QW not used for medicare anymore?? I didn't know about the code change until I asked on here, so I went back and sent over 40 corrected claims for urine tests we have done in 2011. I sent G0434QW and they have ALL been denied for incomplete/incorrect/invalid modifier. What the heck is goin on!!


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## RebeccaWoodward*

There was a recent update.  Is it possible these denied prior to the update?

Effective immediately, code G0434QW is added to the CLFS. Code G0434 can describe a CLIA waived test. The use of the QW modifier to indicate a CLIA waived test is necessary for accurate claims processing. 

http://www.cignagovernmentservices.com/partb/pubs/news/2011/0311/cope14029.html


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## LuluBarr

yes they were, so does that mean that I should remove the modifier for claims submitted before that update? Maybe I should just call them and explain maybe they can reprocess it.


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## LuluBarr

So I called Medicare regarding these denied G0434QW claims and they said that CLIA waiver type 2 certificates will not get paid for this code. We can't bill for these CLIA waived tests with a CLIA certificate of waiver?? That doesn't make any sense. Does anyone have more information on this??


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