We're new to the drug testing in the office thing. We are CLIA certified. Dr. just started charging yesterday. Dr. said we use 80101 CPT code, but he didn't say anything about units of service. ??? How do we know how many units of service to charge? Do we charge for each test (drug classes) that is listed, or 1 UOS for all the tests. Charging for each test doesn't seem right, since you're only doing one urine screen. The current Medicare reimbursement for our area is $19.72.
We purchased the iCup. The instruction sheet says "a rapid, one step screening test for the simultaneous, qualitative detection of multiple drugs and drug metabolites in human urine." It says it tests for: AMP/BAR/BUP/BZO/COC/THC/MTD/mAMP/MDMA/MOP/OPI/OXY/PCP/PPX/TCA
So, I'm assuming that we would use the G0431, for Medicare? According to my bulletin, Medicare won't pay for 80101 after 1/1/10. https://www.noridianmedic..._Drug_Screen_Testing.htm
The info. I just got today from WA State Workers Comp is listed below:
A new payment policy for drug screening will go into effect on January 1, 2011.
Drug Screening: The insurer will pay for drug screening conducted in the office setting by a laboratory with a Clinical Laboratory Improvement Amendment (CLIA) certificate of waiver and confirmation testing performed at a laboratory not requiring a CLIA certificate of waiver.
Codes that can be billed - Effective 1/1/2011 the department will pay for drug screening using the following CPT® and HCPCS codes:
· 80100, Drug screen, qualitative; multiple drug classes chromatographic method, each procedure.
· 80102, Drug confirmation, each procedure.
· G0431, Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class.
· G0434, Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter.
· 80100 and 80102 are only payable to laboratories that do not require a CLIA certificate of waiver.
· G0431 is limited to one unit per day per patient encounter for laboratories with a CLIA certificate of waiver. Laboratories that do not require a CLIA certificate of waiver may bill more than one unit per day per patient encounter.
· G0434 is limited to one unit per day per patient encounter regardless of the CLIA status of the laboratory.
Codes that are not covered - Effective 1/1/2011 the following CPT codes are not covered by the insurer:
Info I got from another forum said:
Deleted - G0430
Revised - G0431: Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter
New - G0434: Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter
NEW: 80104: drug screen, qualitative, multiple drug classes, other than chromatographic method, each procedure
CPT Changes 2011 says: CPT Code 80104 has been established to report a specific drug screen, qualitative analysis by multiplexed method for 2 -15 drugs or drug classes (e.g. multidrug screening kit).â€ And description of procedure states this code is used when the clinician performs a rapid urine toxicology screen using a multidrug screening device that simultaneously screens for a specified number of drug classes.
Soooo, for those of us currently billing 80101 x ___units or G0431 x ___units for rapid drug screening tests done in the office will need to change to either 80104 or G0434 and bill only ONE UNIT."
Which CPT code should I use for non-Medicare & Medicare and how many units of service should you be billing for?
Any help anyone can provide would be greatly appreciated.
Melinda Brown, CMBS