Urine Drug Screen 80101 or G0431
- We're new to the drug testing in the office thing. We are CLIA
certified. Dr. just started charging yesterday. Dr. said we use 80101
CPT code, but he didn't say anything about units of service. ??? How
do we know how many units of service to charge? Do we charge for each
test (drug classes) that is listed, or 1 UOS for all the tests.
Charging for each test doesn't seem right, since you're only doing one
urine screen. The current Medicare reimbursement for our area is
We purchased the iCup. The instruction sheet says "a rapid, one step
screening test for the simultaneous, qualitative detection of multiple
drugs and drug metabolites in human urine." It says it tests for:
So, I'm assuming that we would use the G0431, for Medicare? According
to my bulletin, Medicare won't pay for 80101 after 1/1/10.
The info. I just got today from WA State Workers Comp is listed below:
A new payment policy for drug screening will go into effect on January
Drug Screening: The insurer will pay for drug screening conducted in the
office setting by a laboratory with a Clinical Laboratory Improvement
Amendment (CLIA) certificate of waiver and confirmation testing
performed at a laboratory not requiring a CLIA certificate of waiver.
Codes that can be billed - Effective 1/1/2011 the department will pay
for drug screening using the following CPT® and HCPCS codes:
· 80100, Drug screen, qualitative; multiple drug classes
chromatographic method, each procedure.
· 80102, Drug confirmation, each procedure.
· G0431, Drug screen, qualitative; single drug class method
(e.g., immunoassay, enzyme assay), each drug class.
· G0434, Drug screen, other than chromatographic; any number of
drug classes, by CLIA waived test or moderate complexity test, per
· 80100 and 80102 are only payable to laboratories that do not
require a CLIA certificate of waiver.
· G0431 is limited to one unit per day per patient encounter
for laboratories with a CLIA certificate of waiver. Laboratories that do
not require a CLIA certificate of waiver may bill more than one unit per
day per patient encounter.
· G0434 is limited to one unit per day per patient encounter
regardless of the CLIA status of the laboratory.
Codes that are not covered - Effective 1/1/2011 the following CPT codes
are not covered by the insurer:
Info I got from another forum said:
Deleted - G0430
Revised - G0431: Drug screen, qualitative; multiple drug classes by high
complexity test method (e.g., immunoassay, enzyme assay), per patient
New - G0434: Drug screen, other than chromatographic; any number of drug
classes, by CLIA waived test or moderate complexity test, per patient
NEW: 80104: drug screen, qualitative, multiple drug classes, other than
chromatographic method, each procedure
CPT Changes 2011 says: CPT Code 80104 has been established to report a
specific drug screen, qualitative analysis by multiplexed method for 2
-15 drugs or drug classes (e.g. multidrug screening kit).â And
description of procedure states this code is used when the clinician
performs a rapid urine toxicology screen using a multidrug screening
device that simultaneously screens for a specified number of drug
Soooo, for those of us currently billing 80101 x ___units or G0431 x
___units for rapid drug screening tests done in the office will need to
change to either 80104 or G0434 and bill only ONE UNIT."
Which CPT code should I use for non-Medicare & Medicare and how many
units of service should you be billing for?
Any help anyone can provide would be greatly appreciated.
Melinda Brown, CMBS
[Non-text portions of this message have been removed]