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campglo

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Cigna audit. We used H0003 with physician report- Cigna states we should have used G0431 we feel we have used proper code as both are basically the same. Can I get some support as they are requesting a refund unless I can substantiate. The person I used to help me with coding has passed on. thanks
 
The H0003 is not payable by Medicare and other payers may have the same stance. If it is not in the Cigna fee schedule then it will not be a payable service. Is there a reason to not use the G0431?
 
campglo said:
Cigna audit. We used H0003 with physician report- Cigna states we should have used G0431 we feel we have used proper code as both are basically the same. Can I get some support as they are requesting a refund unless I can substantiate. The person I used to help me with coding has passed on. thanks
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Generally speaking the H series of codes are specifically for Medicaid claims. If this was a commercial insurance claim for 2015, it should have been G0431. For 2016 claims, the code changed to G0479.
 
Walker22 said:
Generally speaking the H series of codes are specifically for Medicaid claims. If this was a commercial insurance claim for 2015, it should have been G0431. For 2016 claims, the code changed to G0479.
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When I run the H codes thru the fee schedule they all state non payable by Medicare. Sorry yes the G0431 was deleted Dec 31, 2015.
 
Generally speaking the H series of codes are specifically for Medicaid claims. If thi

A coder recommended this code as it stated 23 units, we do not bill Medicare or Medicaid. If it is a code just for Medicaid that means it cannot be used for commercial carriers? As you can see I am new at this. G0431 you only bill 1 unit-
Cigna now is refusing to pay or wants refunds and is paying at the new 2015 rates instead of the 2011 guidelines and they are only paying 1 unit of the G0431 at $69.00 and deny if you bill 23 units. Can someone help me?
 
mitchellde said:
When I run the H codes thru the fee schedule they all state non payable by Medicare. Sorry yes the G0431 was deleted Dec 31, 2015.
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Yes, you are correct, they are non-payable by MediCARE. I was referencing the wording at the beginning of the H codes section of the HCPCS book where it states H codes are used for MediCAID. :)
 
campglo said:
A coder recommended this code as it stated 23 units, we do not bill Medicare or Medicaid. If it is a code just for Medicaid that means it cannot be used for commercial carriers? As you can see I am new at this. G0431 you only bill 1 unit-
Cigna now is refusing to pay or wants refunds and is paying at the new 2015 rates instead of the 2011 guidelines and they are only paying 1 unit of the G0431 at $69.00 and deny if you bill 23 units. Can someone help me?
Click to expand...

G0431 should be billed 1 unit per date of service. This one unit covers all the presumptive tests done during that encounter. Does that answer your question?
 
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