Loading ...
Sorry, an error occurred while loading the content.

Urine Drug Screen 80101 or G0431

Expand Messages
  • Melinda
    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
    Message 1 of 1 , Dec 2, 2010
    • 0 Attachment
      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
      $19.72.

      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:
      AMP/BAR/BUP/BZO/COC/THC/MTD/mAMP/MDMA/MOP/OPI/OXY/PCP/PPX/TCA

      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.
      https://www.noridianmedicare.com/shared/partb/bulletins/2010/264_aug/CPT\
      _G0431_Replaces_CPT_80101_for_Drug_Screen_Testing.htm
      <https://www.noridianmedicare.com/shared/partb/bulletins/2010/264_aug/CP\
      T_G0431_Replaces_CPT_80101_for_Drug_Screen_Testing.htm>

      https://www.noridianmedicare.com/provider/updates/docs/mm7140_81010_proc\
      edure_status_indicator.pdf%3f
      <https://www.noridianmedicare.com/provider/updates/docs/mm7140_81010_pro\
      cedure_status_indicator.pdf%3f>

      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
      1, 2011.



      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
      patient encounter.



      Payment limits
      · 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:
      · 80101
      · 80104

      Info I got from another forum said:

      "For Medicare:
      Deleted - G0430
      Revised - G0431: Drug screen, qualitative; multiple drug classes by high
      complexity test method (e.g., immunoassay, enzyme assay), per patient
      encounter
      New - G0434: Drug screen, other than chromatographic; any number of drug
      classes, by CLIA waived test or moderate complexity test, per patient
      encounter

      Non-Medicare:
      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).” 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
      classes.

      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
      Ins Biller




      [Non-text portions of this message have been removed]
    Your message has been successfully submitted and would be delivered to recipients shortly.