Medicare Drug Screen Testing

on Wednesday, 23 February 2011. All News Items

CMS recently released a Special Edition MLN Matters Article (SE1105) concerning Medicare drug screen testing. The article addresses the proper billing, effective January 1, 2011, of HCPCS codes G0434, a new code for 2011, and G0431, revised description for 2011.

Per the article, HCPCS code G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter) is to be used to report “very simple testing methods, such as dipsticks, cups, cassettes, and cards, that are interpreted visually, with the assistance of a scanner, or are read utilizing a moderately complex reader device outside the instrumented laboratory setting (i.e., non-instrumented devices.)”

HCPCS code G0431 (Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter) is for reporting “more complex testing methods, such as multi-channel chemistry analyzers, where a more complex instrumented device is required to perform some or all of the screening tests for the patient.” “Instrumented systems” is further defined as durable systems capable of withstanding repeated use.

Note that both codes are to be reported only once per patient encounter regardless of the number of drug classes tested.

In addition to the code explanations given above, the article reiterates that G0434 is to be used to report drug screen testing using test(s) that are classified as CLIA moderate complexity test(s) and G0431 for high complexity test(s). Since a number of drug screen tests performed on instrumented systems are classified as moderate complexity, this leaves some confusion regarding how to bill for these tests. MMP, Inc. is seeking further clarification regarding this issue from Cahaba GBA, the Alabama A/B MAC.

Providers should confirm a test’s status (CLIA moderate or high complexity) with the test manufacturer. Laboratories with a CLIA certificate of waiver may only perform tests classified as waived (G0434) and should report these line items with a QW modifier. Laboratories with a CLIA certificate of compliance or accreditation do not append the QW modifier to claim lines.

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