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2016 CMS Drug Testing Codes: G0477, A Change You Should Know About

Posted by ToxTests Admin on



It’s that time of year again — time for the Center for Medicare & Medicaid Services (CMS) to change its fee schedules and current coding practices.


As of January 1, 2016, you need to know about the changes that could affect your reimbursement.

If you’re a CLIA-waived practice or lab, then you know that using CLIA-waived drug tests is the way to ensure you’ll get reimbursed for the test. We field a lot of calls about which codes to use, so this blog post is intended to give you some clarity about coding.

Just a note: Every private and public insurance system has different rules about reimbursement, so it’s always best to consult your medical billing team to verify that you’ll be reimbursed for your CLIA-waived test.

In 2015, the codes related to Presumptive Drug Testing were CPT code 80300 and HCPCS code G0434.

That was 2015, and as of 2016, those codes are no longer valid.

In 2016, there’s just one CMS Drug Testing code that covers the types of Presumptive Drug Testing we offer here at ToxTests.

The 2016 code is: G0477. Use this code for the Presumptive Drug Testing screens you obtain here at ToxTests.

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This is from the CMS website:

“Code: G0477 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg, immunoassay) capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.”

As noted in that quote, the 2016 CPT says to use the code per date of service.

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There are other changes to the CMS Drug Testing codes, but those fall outside the parameters of what we do here. For detailed information about the CMS Drug Testing code changes for 2016, check out CMS’ 2016 Clinical Laboratory Fee Schedule.

Have more questions?

Still not sure how the changes are going to affect you and your reimbursement process?

Get in touch today on the ToxTests Contact Us page and we may be able to help!

Disclaimer:

* ToxTests 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.*


** Use Coupon Code CLIA20OFF for 20% off ANY CLIA-waived Cup found HERE **


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