CMS is capping G0461 at 1!

January 30, 2014

The MUE denial is effectively in place for G0461 (aka 88342). Yes, they are allowing only one unit per date of service. If there is more than one unit billed because there is more than one specimen reviewed, you will be denied. The additional units must be appended with the appropriate modifier –, 59, 76, or 91 depending on your MAC). Note: the Medicare advantage product lines are quickly jumping on board. Be prepared to make changes to your front end edit process. More to come from the commercial community when we see how they are working the 88342/88343 changes for 2014.

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