Wiki GO434 vs G0431

[angiemeade]

We have a moderate complex lab and we are using an assay machine to do qualitative urine drug screens. We do 12 test and one validity test. We would like to know, because we are using an assay machine is this considered moderate or high complex testing and what is the appropriate code G0431 or G0434? Thank you!! Any help is greatly appreciated.

 

[brockorama01]

The answer is...the machine does not determine whether you bill G0431 or G0434, its your level of complexity. You can only bill the G0434 for ONE UNIT as moderately complex. Note: Is probably not worth - between the staff and the reagents, it probably costs you $20 to run the test and Medicare only pays about $16.

If you go to highly complex then you can use the G0431 x number of classes.

Brock Berta, CPC-A, MBA
Billing Czar

 

[marvelh]

Actually, G0431 can also only be billed with a maximum of 1 unit of service

 

[brockorama01]

Oops. You are right. In 2011, they made the code "per encounter" but upped the fee schedule to a base of $102..depending on the state.