Effective Date Regarding Change for CPT Code 80101

on Thursday, 30 September 2010. All News Items

On September 24, 2010, CMS released Transmittal 776 (CR 7140) which clarifies the date for which CPT code 80101 is no longer valid for Medicare purposes. According to the transmittal, which has an implementation and effective date of October 26, 2010, CPT code 80101 is not valid for Medicare billing as of January 1, 2010. For dates of service on and after January 1, 2010, providers should use HCPCS code G0431 in place of 80101 (G0431QW in place of 80101QW for laboratories with a CLIA certificate of waiver). Claims with denials for CPT code 80101 from January 1, 2010 through June 30, 2010 should be resubmitted with HCPCS code G0431. Providers should not resubmit claims if they received payment for 80101.

The CPT/HCPCS descriptions for both 80101 and G0431 are identical: Drug screen, qualitative: single drug class method (e.g. immunoassay, enzyme assay), each drug class.

For more information, see MLN Matters Article MM7140 or Transmittal 776.

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