HCPCS G0431 Drug Screening Edit Postponed

TrailBlazer planned to initiate prepayment review of G0431 effective April 16, 2012; however, the edits for the prepayment review have been postponed until further notice. At this time, TrailBlazer will allow the automated system to identify multiple billing of G0431 and deny those line items billed in excess of the Medically Unlikely Edit (MUE) value published. Effective January 1, 2011, the definition for HCPCS code G0431 was revised to “drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter.” The previous definition was “drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class.” This means that before 2011, providers were able to bill the code once for each individual drug class. The current description combines the drugs into a single unit that may be billed once per day, per beneficiary, per provider. TrailBlazer data analysis of billing HCPCS code G0431 identified payment errors of qualitative drug screens. Multiple units are being billed on a single date of service when the updated code description for 2011 should be reported once per specimen. TrailBlazer Health Enterprises – Medicare Part A and Part B MAC for Jurisdiction 14; comprised of Colorado, New Mexico, Oklahoma and Texas