Medicare Billing for Qualitative Drug Screening

on Wednesday, 20 January 2010. All News Items

CMS recently published MLN Matters Article SE1001 to clarify the descriptions and billing of CPT/HCPCS codes G0430, G0431, 80100, and 80101 for qualitative drug screen services for the period of January 1, 2010 through March 31, 2010. 

The current definitions of all test codes addressed in this article are:

  • CPT Code 80100 – Drug screen, qualitative; multiple drug classes chromatographic method, each procedure
  • G0430 – Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure
  • CPT Code 80101 – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class
  • CPT Code 80101QW – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class
  • G0431 – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

From January 1, 2010 through March 31, 2010, when performing a qualitative drug screening test for multiple drug classes using chromatographic methods, CPT Code 80100 is the appropriate code to bill.  If the qualitative drug screening test for multiple drug classes uses methods other than chromatographic, new HCPCS code G0430 is the appropriate code to bill.

For the same time frame, if a qualitative drug screening test for a single class of drugs is performed, regardless of the testing methodology, clinical laboratories that do not require a CLIA certificate of waiver should bill new test code G0431.  CLIA certificate of waiver laboratories should continue to bill CPT code 80101QW.

CMS will provide further direction on this issue by April 1, 2010.

It is important to note that CPT Codes 80100 and 80101 are assigned a status indicator of ‘E’ in the OPPS Addendum B indicating these codes are not covered by Medicare.  Discussion at the January CMS Hospital Open Door Forum indicated this would be corrected in the April OCE update and would apply retroactively.  There was no indication in the MLN Matters article of how Medicare will handle payment of these codes at this time.

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