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Medicare CPT® 80101 Denial
I have several patients that have a primary insurance that requires we bill CPT® code 80101, I bill the number of units that we use for the patient of course- however, when the primary insurance wont pay (Deductible, Etc...) and Medicare is secondary, Medicare WILL NOT pick up the balance or a part of the balance for this code. The denial is that the modifier is inconsistent with the code used or a required modifier is missing. I am using Modifier QW which is what the primary insurance requires. So my dilemma here is that the codes I use for the primary insurance are not accepted by the secondary insurance and we end up with no payment from either??
re: Medicare CPT® 80101 Denial
test code G0431 is a direct replacement for CPT® Code 80101. – G0431-QW= Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class.
re: Medicare CPT® 80101 Denial
I have used the G0434 in replacement of 80101 and received denials as well ( not from Medicare but from- Universal Healthcare and other insurances with medicare plans) that state we "altered the claim" or "the EOB does not match the claim submitted" but that is the only way they will accept the claim to even consider payment. I even explain on the bottom of the EOB we submit with the claim the reasoning behind this.
re: Medicare CPT® 80101 Denial
They make the rules so appeal with them