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Regence BCBSO Reimbursement Policy

Drug Screening Qualitative

Topic: Drug Screening Qualitative Date of Origin:  January 2011
Section: Medicine Policy No: 106
Last Reviewed: November 2013 Last Revised: November 2013
Approved: November 2013  

This policy applies to professional and facilities (hospitals, surgery centers, kidney centers, etc…)   

Definitions

80100 – Drug screen, qualitative; multiple drug classes chromatographic method, each procedure

80101 - Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure

80104 - Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure

G0431 – Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter

G0434 - Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter

Policy Statement

NOTE: This policy has been revised. The revised policy will be effective May 1, 2014. To view the revised policy, click here.

Drug screening codes are eligible for reimbursement of one unit per date of service. Claims billed by a facility (billed on a UB 92) will be allowed one unit and the remaining units will be denied as provider liability. Claims billed by professional providers (billed on a CMS 1500) will be allowed one unit and the remaining units will be denied.

Independent laboratories and outpatient hospitals may be reimbursed for multiple procedures for code 80101 on the same date of service by appending modifiers -59 (distinct procedural service) or -91 (repeat clinical diagnostic laboratory test). The submission of modifier -59 or -91 appended to a procedure code indicates that documentation is available in the patient’s records for review upon request that will support the need for repeat, or the distinct or independent identifiable nature of the service submitted with the modifier.

Code 80100 (not a strip, dip card, or cassette) is eligible for reimbursement when multiple drug classes are tested in a laboratory setting.  The laboratory must be a Clinical Laboratory Improvement Amendments (CLIA) Certified or CLIA Exempt Laboratory.  Use of the code requires analysis by chromatography. It is eligible once per procedure, which is defined as a unique combination of a chromatographic stationary phase and mobile phase.  For example, if multiple drug classes require one stationary phase and one mobile phase, then one unit of CPT 80100 would be billed.  If multiple drug classes require one stationary phase and three mobile phases, then three units of CPT 80100 would be billed.

Code 80101 (e.g. single strip) is eligible when a single drug class is tested in an office, laboratory, or facility setting.  Use of the code requires one test kit per drug class tested on one or more specimens.  For example, CPT 80101 may be billed 5 times during a single encounter on one specimen, if 5 separate drug classes (e.g. Amphetamines/ Methamphetamines, Barbiturates, Benzodiazepines, Cannabinoids (Marijuana or THC), Cocaine/Cocaine Metabolites, Opiates, Phencyclidine, Propoxyphene) are tested.  Each drug class tested must have its own test kit.  Multiple drugs tested using a single test kit is not eligible for separate reimbursement with CPT 80101.

Code 80104 (e.g. cassette or dip card) is eligible when multiple drug classes are tested in an office, laboratory, or facility setting.  Use of the code requires a test kit and may only be billed once for all drug classes determined with a single test kit on a single specimen.

Code G0431 (not a strip, dip card, or cassette) is eligible when multiple drug classes are tested in a laboratory setting.   Use of the code requires a high complexity test method, and is billed once per patient encounter.    Each patient encounter must have a unique date and time of service.

Code G0434 (e.g. strip, dip card, or cassette) is eligible when any number of drug classes is tested in an office, laboratory or facility setting.  Use of the code requires a CLIA waived or moderate complexity test, and is billed once per patient encounter.  Drug screening analysis utilizing multiple specimens and/or multiple tests kits from the same encounter are billed as a single unit.  Drug screening analysis using specimen(s) and test kit(s) from a separate encounter on the same date of service, may be billed as a second unit with supporting documentation.

If a provider wishes to appeal a payment determination please follow our Provider Appeals process located in the Claims & Billing section of our Provider Web Site.

References

None

Cross References

None


Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.

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