Submit drug testing services to Moda Health for all Commercial and Medicare Advantage lines of business using CPT codes 80305 – 80307 and HCPCS codes G0480 – G0483, G0659 as appropriate. Only one of the three presumptive codes (80305, 80306, 80307) may be billed per day. Select the most appropriate code for the method of testing performed.
Full Answer
Is 80305 covered by Medicare?
Jun 19, 2018 · Presumptive Drug Testing CPT Codes Medicare and private payers require the same codes to report presumptive drug testing: 80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges) includes sample …
Does 80305 need QW modifier?
CMS Medicare Urine Drug Testing Guidelines . AllWays Health Partners Reimburses • CPT codes 80305-80307; 1 unit per date of service • HCPCS codes G0480-G0483; 1 unit per date of service ... • CPT codes 80305 and/or 80306 are eligible for reporting in the physician office setting. CPT
How often will Medicare pay for 83036?
Apr 12, 2017 · Re-Submitting. Medicare's policy on the new CLIA waved code (80305) was not effective until 4.1.17, to be implemented on 4.3.17. You should have received denials on the code billed without the modifier -QW indicating the type of provider is ineligible. I have just started rebilling all my 80305-QW's, but haven't received a response back yet.
Does Medicare cover CPT 80305?
Aug 29, 2019 · Claims for drug screening services are payable under Medicare Part B in the following places of service: office (11), urgent care (20), independent clinic (49), federally qualified health center (freestanding) (50), rural health clinic (freestanding) (72), and independent laboratory (81). ... The following CPT codes are Non-Covered by Medicare ...
What CPT code replaced 80305?
Is CPT code 80305 CLIA waived?
The new tests are: 80305-QW American Screening Corporation, Inc., Precision DX Quick Cup M300.Jan 30, 2019
Does Medicare cover urine drug screens?
What does CPT code 80305 test for?
What CPT codes are CLIA-waived?
What does CLIA-waived mean?
What is the CPT code for a urine drug screen?
Urine drug screen (USDL) is a group test that is currently billed at the group test level of CPT code 81000.Sep 24, 2009
What does G0480 test for?
What is the ICD 10 code for urine drug screen?
For monitoring of patient compliance in a drug treatment program, use diagnosis code Z03. 89 as the primary diagnosis and the specific drug dependence diagnosis as the secondary diagnosis.
Can 81001 be billed 80307?
What is the difference between 80305 and 80306?
Can 80305 and G0480 be billed together?
What is the code for drug testing?
Definitive Drug Testing. Codes 80320-80377 report definitive drug testing of specific type (s) of drug (s) such as alcohol, amphetamines, and anabolic steroids, as well as drugs or substances that are not otherwise specified.
What is a presumptive drug test?
Presumptive drug testing services may be performed prior to definitive drug screen testing (80320-80377), when a provider wants to rule out illicit drug uses or to confirm the presence of a particular drug class without identifying individual drugs; or, to distinguish between structural isomers. For example, a patient using prescription opioids ...
Who is John Verhovshek?
John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD L34645 Drug Testing.
ICD-10-CM Codes that Support Medical Necessity
For monitoring of patient compliance in a drug treatment program, use diagnosis code Z03.89 as the primary diagnosis and the specific drug dependence diagnosis as the secondary diagnosis.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
Is the A18 a valid test?
A18. Yes, it would be considered valid for the signature requirement; however, the test is subject to medical necessity by the provider's intent that the clinical diagnostic test should be performed.
Does Moda Health follow CMS guidelines?
Moda Health will follow the CMS coding guidelines for reporting drug testing procedures, as outlined in the CMS Calendar Year (CY) 2017 Clinical Laboratory Fee Schedule (CLFS) Final Determinations document posted on the CMS website. (CMS12)
Does Moda Health accept confirmation testing?
Moda Health follows CMS guidelines, which do not recognize separate procedure codes for confirmation testing. This service is considered included in CPT codes 80305 – 80307 and HCPCS codes G0480 – G0483, G0659, and is not eligible for separate reimbursement under any procedure code, including an unlisted procedure code. If records review determines that confirmation testing has been submitted and inadvertently allowed, the provider will not be allowed to retain reimbursement. The claim will be adjusted to deny the confirmation testing as included in the primary drug testing service, and a refund request will be generated.
What is a definitive drug class test?
AMA definition: Definitive Drug Class testing are qualitative or quantitative tests to identify possible use or non-use of a drug. These tests identify specific drugs and associated metabolites, if performed. A presumptive test is not required prior to a definitive drug test. (AMA4)
What is AMA drug test?
AMA definition: Drug confirmation is a repeat of the test to reduce the risk of a false positive or false negative result. Confirmation tests can be performed on qualitative and/or quantitative testing. (AMA4)
What is the purpose of Moda Health reimbursement policy?
The purpose of this Reimbursement Policy is to document Moda Health’s payment guidelines for those services covered by a member’s medical benefit plan. Healthcare providers (facilities, physicians and other professionals) are expected to exercise independent medical judgment in providing care to members. Moda Health Reimbursement Policy is not intended to impact care decisions or medical practice.
What is clinical drug testing?
The testing may be used to detect prescribed, therapeutic drugs, prescription drugs of abuse, illicit drugs, and/or other substances such as nicotine.
What are the components of a urinalysis?
The components of a urinalysis include an evaluation of physical characteristics (color, odor, and opacity); determination of specific gravity and pH; detection and measurement of protein, glucose, and ketone bodies; and examination of sediment for blood cells, casts, and crystals. Some laboratories include screening for leukocyte esterase ...
What is a dipstick?
Dipsticks are chemically impregnated reagent (reactive) strips that allow for quick determination of pH, protein, glucose, ketones, bilirubin, hemoglobin, nitrate, leukocyte esterase, and urobilinogen. The tip of the dipstick is impregnated with chemicals that react with specific substances in the urine to produce colored end products.
What is a urinalysis?
It aids in diagnosing and following the course of treatment in diseases of the kidney and urinary system and in detecting disorders in other parts of the body such as metabolic or endocrinologic abnormalities in which the kidneys function normally. The components of a urinalysis include an evaluation of physical characteristics (color, odor, ...