HCPCS code G0431 (drug screen, qualitative: multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter) should only be billed once per patient encounter. TrailBlazer data analysis has identified code G0431 is being incorrectly reported per patient on multiple claims, multiple claim line details and also with the 59 modifier.
This code may only be reported if the drug screen test(s) is classified as a CLIA high-complexity test(s) with the following restrictions:
• G0431 may only be reported when tests are performed using instrumented systems (i.e., durable systems capable of withstanding repeated use).
• CLIA waived tests and comparable non-waived tests may not be reported under test code G0431; they must be reported under test code G0434.
• CLIA moderate complexity tests should be reported under test code G0434 with one (1) Unit of Service (UOS).
• G0431 may only be reported once per patient encounter.
• Laboratories billing G0431 must not append the QW modifier to claim lines.
Medicare Part A and Part B MAC for Jurisdiction 14; comprised of Colorado, New Mexico, Oklahoma and Texas