2017 New CPT Codes for Billing Coding Presumptive Drug Class Procedures, UDS, Urinary Drug Screening and Immunoassay | Point of Care UDT

Wow! we have new codes effective January 1, 2017 for Presumptive Screening Toxicology CPT codes.

These will replace both the AMA CPT and Medicare’s HCPCS for presumptive drug testing.

The following AMA CPT codes for presumptive urine drug testing are now DELETED and no longer recognized effective January 1st 2017

80300 – Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures (e.g., immunoassay) capable of being read by direct optical observation, including instrumented-assisted when performed (e.g.. Dipsticks, cups, cards, cartridges) per date of service
**** ONLY report once, regardless of the number of drug class per date of service

80301 – single drug class methods, by instrumented test systems (e.g. Discrete multichannel chemistry analyzers utilizing immunoassay or 2 enzyme assay), per date of service
**** Report ONLY once for a single or multiple procedures performed, regardless of the number of performed, classes or results on any date of service

80302 – Drug screen, presumptive, single drug class from Drug Class List B, by immunoassay (e.g. ELISA) or non-TLC chromatography without mass spectrometry (e.g. GC, HPLC), each procedure
**** Report each drug class once per date of service

80303 – Drug screen, any number of drug classes, presumptive, single or multiple drug class method; thin layer chromatography procedure(s) (TLC) (e.g. Acid, neutral, alkaloid plat), per date of service
**** Report single or multiple drug procedures, once per day of service

80304 – not otherwise specified presumptive procedure (e.g. TOF, MALDI, LDTD, DESI, DART), each procedure
**** Report single or multiple drug screenings, per testing site, per date of service, per each procedure

DELETED HCPCS G-Codes for Urine Drug Screening for 2017

G0477 Drug tests(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 validation when performed, per date of service.

G0478 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg immunoassay) read by instrument-assisted direct optical observation (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.

G0479 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers (eg, immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service.

Your 2017 Presumptive Urine Drug Testing CPT Codes

TAKE NOTE:  CMS will recognize the new 2017 AMA published drug testing CPT codes 80305, 80306 and 80307 as replacement codes for HCPCS codes G0477, G0478 and G0479. CPT codes 80305, 80306 and 80307 will be eligible for one (1) unit of reimbursement per date of service.

CPT code 80305 Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipstick, cups, cards, cartridges) includes sample validation when performed, per date of service (crosswalk to 80300 or G0477).
**** ONLY report once, regardless of the number of drug class per date of service
**** CPT code 80305 will be eligible in the physician office setting.

CPT 80306 Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or procedures, (e.g., immunoassay) read by instrumented assisted direct optical observation (e.g., dipstick, cups, cards, cartridges) includes sample validation when performed, per date of service (crosswalk to 80300 or G0478).
**** ONLY report once, regardless of the number of drug class per date of service
**** CPT code 80306 will be eligible in the physician office setting.

CPT 80307 Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or procedures, by instrument chemistry and analyzers (e.g., utilizing immunoassay [EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (e.g., GC, HPLC), and mass spectrometry either with or without chromatography, (DAT, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service (crosswalk to 80301, 80302, 80303, 80304 and G0479).

Keypoints to always remember:

  1. Render service based on medical necessity and document the service on the patients record
  2. 80305 and 80306  can only be reported one unit of service per patient encounter, regardless of the number of drug classes being tested
  3. 80305 and 80306 can not be reported together (absolutely NO)
  4. Use and report CPT Codes 80305 and 80306 for Medicare claims
  5. Append Modifier QW if your practice has CLIA Waive Certificate

2017 Definitive CPT Code for Drug Screen Testing remains the same

G0480 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed.
G0481 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed.
G0482 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed.)
G0483 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed.

DON’T MISS THE OPPORTUNITY (For routine collection of venous blood, use 36415) – some payers will cover it. Make sure you check!

REFERENCES: 

2017 CPT CODE BOOK *** CPT IS A TRADEMARK AND OWNED BY THE AMERICAN MEDICAL ASSOCIATION

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Downloads/CY2017-CLFS-Codes-Final-Determinations.pdf

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