G0480
ActiveDrug test def 1-7 classes
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed
MUE — Medically Unlikely Edits
Maximum units of G0480 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| Outpatient Hospital | 1 |
| Practitioner Services | 1 |
Source: CMS Medicare NCCI Medically Unlikely Edits
NCCI Edits
The following codes cannot be billed together with G0480 without appropriate documentation.
| Column 2 Code | Modifier |
|---|---|
| G0659 | Modifier cannot bypass edit |
Source: CMS National Correct Coding Initiative (NCCI)
NCCI Edits — Reverse Direction
G0480 cannot be billed together with the following column 1 codes without appropriate documentation.
| Column 1 Code | Modifier |
|---|---|
| G0481 | Modifier cannot bypass edit |
| G0482 | Modifier cannot bypass edit |
| G0483 | Modifier cannot bypass edit |
Source: CMS National Correct Coding Initiative (NCCI)