Forum - Questions & Answers

Jun 17th, 2016 - cmgmr 4 


How does one go about getting paid for this code/service? As of now we have two major carriers that are paying.

I have Billing asking the "credentialing people" to have this code added to our fee schedule with a certain carrier (why this was not done months ago is beyond me). The "credentialing people" are asking what other code can be used in place of G0480 in the mean time.

Without this code being on our contract with this particular carrier, I am guessing it cannot and will not be paid and there is not another code to use.

Am I correct in assuming the "ball was dropped" and we aren't going to see payment until the fee schedule is corrected?

Silly question, I know; but I need an outsiders input on this!


Jun 20th, 2016 - rphelps 615  1 

re: G0480

I have never found a carrier who pays for this code. What exactly are you billing for?

Jun 23rd, 2016 - LBAROGIANIS 250 

re: G0480

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.

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).

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