Forum - Questions & Answers

Apr 26th, 2016 - taradalyn1 16 

G0477 is being rejected and denied

Did something change with G0477? I haven't had any denials or rejections until last week. I've tried with and without modifier QW, both are being denied. Medicare website tells me nothing. Any help is appreciated!

Apr 28th, 2016 - LBAROGIANIS 250 

re: G0477 is being rejected and denied

Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service

Lay Description (Code):

The CPT® codes used for drug testing (80300-80377) are grouped into drug classes and further broken down into therapeutic assays, presumptive testing, and definitive testing. Medicare is not prepared to accept and process the codes based on drug classes, and has instead divided the procedures into the presumptive and definitive categories only. Providers should report a HCPCS Level II G code based on whether the testing is presumptive or definitive in nature. For presumptive testing, only one of the three presumptive codes (G0477-G0479) may be reported per day. For definitive testing, only one of the four definitive codes (G0480-G0483) may be reported per day. The unit used to determine the correct definitive G code assignment is the drug class. A drug class is used only once per day to determine the correct G code assignment. Report G0480 for the definitive test of one to seven drug classes; G0481 for eight to 14 drug classes; and G0482 for 15 to 21 drug classes.


Section Notes - Procedures/Professional Services (Temporary) - (G0008-G9678)
The G codes are used to identify professional health care procedures and services that would otherwise be coded in CPT® but for which there are no CPT® codes.Please refer to your CPT® book for possible alternate code(s).

Apr 28th, 2016 - taradalyn1 16 

re: G0477 is being rejected and denied

Thank you for your input. After several days of searching, I finally found (on medicare webiste) a document stating there is a "system error" and these denied claims will be reprocessed automatically. Hope this helps anyone else who has had the same problem.

Apr 28th, 2016 - churt31024 9 

re: G0477 is being rejected and denied

Medicare g0477-qw modifier
uhc 80304
uhc Medicare 80304-qw modifier
bcbc g0477

May 18th, 2016 - ERICA6584 1 

re: G0477 is being rejected and denied


I'm billing G0477-QW to Medicare, but still getting rejected. Medicare said they had issues processing this code this year, but they were supposed to fix it in early April. Has anyone else been having issues recently?

May 19th, 2016 - churt31024 9 

re: G0477 is being rejected and denied

I have found that it's been rejected due to not medical necessity because not enough dx code to support the dx. You have to have two or more dx code to support it like F10.0, F10.20, F14.20, G47.00, M06.9, F60.3, M17.9, M48.06, M51.34, M54.4, M54.2, M54.30, F31.62, F31.63, F34.1, F33.9, F39, F41.1, F41.0, F32.2, F19.20, F20.9, F12.20, F12.20, F14.20, I10, M06.9, G44.14, F60.3, F41.9, F60.3, G89.4, G89.29, F20.0, F20.9 AND ETC.

May 19th, 2016 - blanche22 20 

re: G0477 is being rejected and denied

This might help. here is a future LCD that we just received for Nevada

Controlled Substance Monitoring and Drugs of Abuse - Effective June 28, 2016
The following Local Coverage Determination (LCD) has completed the Open Public and Carrier Advisory Committee comment period and is now finalized. L36668

We had rejections at the beginning of the year because we used the modifier QW and when I called they explained that the modifer wasn't to start till April 1 2016.

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