** We have a blog post regarding the 2016 CMS changes. Click link to read. **
CPT Code changes seem to always leave us with lots of questions - and 2015 was no exception. Here, we briefly answer the 7 most frequently asked questions regarding the CPT codes changes for drug testing.
When did the new codes go into effect?
January 1, 2015
Why the new codes?
The American Medical Association created these new CPT codes in order to more clearly define the drug testing methodologies employed for preliminary drug screening and confirmation.
What are the new codes?
CPT 80300 - Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg immunoassay) capable of being read by direct optical observation, including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges), per date of service
CPT 80301 - Drug screen, any number of drug classes from Drug Class List A; single drug class method, by instrument test systems (eg, discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service
CPT 80302 - Drug screen, presumptive, single drug class from Drug Class List B, by immunoassay (eg, ELISA) or non-TLC chromatography without mass spectrometry (eg, GC, HPLC), each procedure
CPT 80303 - Drug screen, any number of drug classes, presumptive, single or multiple drug class method; thin layer chromatography procedure(s) (TLC) (eg, acid, neutral, alkaloid plate), per date of service
CPT 80304 - Drug screen, any number of drug classes, presumptive, single or multiple drug class method; not otherwise specified presumptive procedure (eg, TOF, MALDI, LDTD, DESI, DART), each procedure
Which codes are used for Rapid Urine Drug Screening (aka UDS, UDT, Point-of-Care, POCT)?
*Do not use codes 80101 or 80104. These 2014 codes have been DELETED.
What codes does CMS presently recognize?
CMS is not recognizing ANY of the new CPT codes (80300-80377) because of a concern for potential overpayment. They maintain that they need more time to gather data in order to determine the proper Medicare payment amount. In the meantime, they have created a series of alphanumeric G-codes that are to be used (which are the existing HCPCS codes). The G-codes (G0434 in the case of rapid drug testing devices such as dips, cups, cassettes) are to be used in the exact same manner as the (now-deleted) 2014 codes were used.
It is assumed that CMS will assign payment levels to the new 2015 codes in 2016.
Click link for CMS Clinical Laboratory Fee Schedule Final Determination Letter.
What are the payment amounts for non-government payers?
Check with you payer and/or billing service provider for this information.
Are we to bill per drug tested or per date of service?
The new 2015 CPT specifies using the code per date of service (see excerpt below).
CPT 80300: Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg immunoassay) capable of being read by direct optical observation, including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges), per date of service
The HCPCS code specifies using the code per patient encounter (see excerpt below)
HCPCS 2015 Code : G0434 : Drug screen, other than chromatographic; any number of drug classes, by CLIA Waived test or moderate complexity test, per patient encounter
* ToxTests.com cannot guarantee reimbursement by any public or private insurance carrier and is not responsible or liable in any way for any result or consequence that follows from the use of this publicly available billing information. Refer to the Center for Medicare & Medicaid Services (www.cms.gov) or other relevant insurance payers for up-to-date coding and state by state reimbursement information.*