November 2, 2017
Effective for dates of service February 1, 2018 and after, we're changing which codes we'll reimburse for Definitive Drug/Qualitative Drug testing.
Effective February 1, 2018 and after, CPT drug testing codes 80320 through 80377 and 83992 will no longer be reimbursed for definitive/qualitative drug testing. We'll only reimburse the following HCPCS codes for any qualitative/definitive drug testing performed:
- G0480-Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers, including, but not limited to, GC/MS (any type) and LC/MS (any type) and enzymatic methods; qualitative or quantitative, all sources, include specimen validity testing, per day, 1-7 drug classes, including metabolites if performed.
- G0481-Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers, including, but not limited to, GC/MS (any type) and LC/MS (any type) and enzymatic methods; qualitative or quantitative, all sources, include specimen validity testing, per day, 8-14 drug classes, including metabolites if performed.
- G0482-Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers, including, but not limited to, GC/MS (any type) and LC/MS (any type) and enzymatic methods; qualitative or quantitative, all sources, include specimen validity testing, per day, 15-21 drug classes, including metabolites if performed.
- G0483-Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers, including, but not limited to, GC/MS (any type) and LC/MS (any type) and enzymatic methods; qualitative or quantitative, all sources, include specimen validity testing, per day, 22 or more drug classes, including metabolites if performed.
- G0659-Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers, including, but not limited to, GC/MS (any type) and LC/MS (any type) and enzymatic methods, performed without method or drug specific calibration, without matrix-matched quality control material or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes.
Only one of these definitive testing codes can be billed per day.
To learn more about the specifics of the upcoming revisions, refer to Payment Policy “Drug Assay Testing” which will be posted on the external portals before the end of November.