G0431 and G0464 Issue

edited May 2017 in Part B Archive
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Hi Everyone,

Our AR team is facing an issue, whenever they receive a denial of CPT codes
for different drug testings from Medicare. They resubmit the claim with
G0431 and/or G0464 codes removing the CPT codes.

But these G series codes cover many CPT codes and the claim amount
decreases significantly, since instead of 4-5 CPT codes, they end up giving
only one G series code.

My question is, can we use these codes multiple times with some appropriate
modifier, so tha claim amount would not vary much??

Any inputs will be highly appreciated.

Thank you
Mayur Mane
Team Leader, AR follow up


  • edited May 2017
    What DOS is this for? If 2016, you should be using G0477-G0479 for in-house and G0480-G0483 for confirmation panels with only one of those codes being billed.

    Thank you,

    Leila Meeks


  • Hello everyone,

    Dear Leila, will you be able to know where i can find information of what the maximum billable units on G codes ( drug confirmation tests) are? for example G0481 and G0480 i noticed some insurances may pay several units on one claim , while Medicare can deny same type of claim for ''too many units billed'' reason.
  • That's a good question. The descriptors for drug screen G-codes G0480-G0483 state "per day," so I don't know why private payers would allow more than one unit of service for one patient on the same day.
  • I am very confused too , as Medicare HMO insurances allow more than one unit on G0480 and G0481. There cases when 8 tests were ordered and all of them had same code for billing G0481 and insurances allowed all 8 units.

    I am not sure if it is proper to bill more than one unit, but if insurances pay i thought it is correct.
  • edited May 2017
    My motto.... just because you can doesn't mean you should!

    Marie Popkin, CPC
    Coding,Consulting & Compliance

  • edited May 2017

    Don Self & Associates, Inc

    305 Senter Ave, Whitehouse, TX 75791
    903 871-1172 fax 480-247-5650
    donself@donself.com web: www.donself.com
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