smbllc
New
Hello, My question is about Drug Screens. I know Medicare has replaced G0477 with 80305 effective 1/1/2017, but the PDF says its effective date is April 1, 2017. They did the same thing last year when they replaced G0434 with G0477. I do remember that having an effective date of April 1, 2016 (found PDF below) and that is when I had to start adding the QW modifier on April 1, 2016. I have billed Medicare with 80305 and added QW modifer and I am being denied. My real question is Has anyone billed with NO modifer and gotten paid for 80305? I know the modifer will be in place after April 1st, 2017 just not sure if it will still deny or if they will come back and pay them later if I bill it without the Modifier until April 2017. In 2016 I billed G0477 without modifier until April 1 2016 and Medicare paid.
My denial reason from Medicare when billing 80305 QW: The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Effective April 1, 2017 https://www.cms.gov/Outreach-and-Edu...ads/MM9956.pdf
Effective April 1, 2016 https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/Downloads/MM9515.pdf
My denial reason from Medicare when billing 80305 QW: The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Effective April 1, 2017 https://www.cms.gov/Outreach-and-Edu...ads/MM9956.pdf
Effective April 1, 2016 https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/Downloads/MM9515.pdf