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Drug Screen Biling

Published on 

Wednesday, March 24, 2010

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CMS Transmittal 6530 released March 19, 2010, provides instructions for the proper use of the CPT and HCPCS codes for drug screening beginning with dates of service April 1, 2010 and after.  Previously released MLN Matters Article SE1001 contains information on drug screen billing for dates of services from January 1, 2010 through March 31, 2010.  The major changes in the latest transmittal are new codes for laboratories with a CLIA certificate of waiver and the deletion of Medicare coverage for CPT codes 80101 and 80101QW.

Effective April 1, 2010:

  • When performing a qualitative drug screening test for multiple drug classes that uses chromatographic methods, CPT Code 80100 is the appropriate code to bill.
  • When performing a qualitative drug screening test for multiple drug classes that does not use chromatographic methods, new test code G0430 is the appropriate code to use for labs that do not require a CLIA certificate of waiver.  Waiver labs would use code G0430QW.
  • When performing a qualitative drug screening test for a single class of drugs, test code G0431 is the appropriate code to use for labs that do not require a CLIA certificate of waiver.  Waiver labs would use code G0431QW. 

New test code G0431 is a direct replacement of CPT code 80101.  Effective April 1, 2010, CPT Code 80101 will no longer be covered by Medicare, and CPT Code 80101QW will be deleted.

For additional information, see MLN Matters Article MM6852.

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This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.