Question 1

What is HCPCS code G0478?

Accepted Answer

HCPCS code G0478 is "Drug test presump opt inst". Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service

Question 2

What category is G0478 in?

Accepted Answer

G0478 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0478?

Accepted Answer

Use G0478 when billing for drug test presump opt inst. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G0478 covered by Medicare?

Accepted Answer

Coverage for G0478 (Drug test presump opt inst) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G0478?

Accepted Answer

Documentation for G0478 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).