Wiki G0431 & g0434

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Michele1229

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Hello -

I need some help from all you laboratory experts. We have a pain mgmt. provider who says they can bill G0431 AND G0434 together on the same day during the same patient encounter. Can they do that? I can't find anything that says you can or you can't.

Not sure what Medicare says on this.
If anyone has advice or a link that would be great.

Thank you!!!
 
G0434 is bundled by NCCI edits into the G0431 code and you cannot use a modifier to bypass this bundling edit.
 
Shelley

Just so I understand clearly your providers are performing a moderate and a high complexity screening on the same date of service for that one specimen?
 
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