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Marilyn Posted Thu 13th of March, 2014 11:45:18 AM

My clinic is CLIA waived. Do we bill Medicare and commercial payors "G0431"?

SuperCoder Answered Fri 14th of March, 2014 09:47:59 AM


Turn to HCPCS Level II for Medicare

You’ll need to report one of the following codes if a physician orders a drug screen for a Medicare beneficiary:

G0431 — Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter
G0434 — Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter.
You can see that CMS has established a two-tier drug-screen coding system that doesn’t align with the distinctions you’d make if you’re reporting CPT® drug test codes.

Know CLIA Certification

The key to selecting the proper HCPCS Level II drug screening code is understanding how the Clinical Laboratory Improvement Amendments (CLIA) categorizes tests into three complexity groups, as follows:

Waived tests
Tests of moderate complexity, including the subcategory of provider-performed microscopy (PPM) procedures
Tests of high complexity.
“You should choose between G0431 and G0434 based on the CLIA complexity classification of the specific lab test you’re using"

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