HCPCS G0464 is officially defined as "Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3)." HCPCS G0464 is referenced in 3 tracked payer policy changes from CareSource, Highmark, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G0464 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
CareSource will enforce a provider type requirement for Ohio Medicaid home health claims: only Provider Type 60 (Medicare Certified Home Health Agencies) may bill G-codes for home health services. Claims submitted with G-codes from any other provider type will be denied. Providers with incorrect provider type classifications must coordinate with the Ohio Department of Medicaid to update their records.
Highmark has corrected a system error where psychotherapy procedure code 90834 was incorrectly flagged as requiring primary code G0464, which had been discontinued. Claims with CPT 90834 will no longer be rejected for missing primary codes, and previously rejected claims are being automatically adjusted for payment.
MDHHS covers HCPCS codes G0477 through G0483 effective January 1, 2016, and covers 81528 for Healthy Michigan Plan only from that date. MDHHS covers L2785 effective April 1, 2016, and discontinued coverage of 76140 and G0464 effective April 1, 2016. Manual updates also cover behavioral health services, applied behavior analysis for children under 21 with autism spectrum disorder, and hospice payment rates for dates of service on or after January 1, 2016.
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