| Drug Screening Qualitative
| Topic:
Drug Screening Qualitative |
Date
of Origin: January 2011 |
| Section: Medicine |
Policy
No: 106 |
| Last Reviewed Date: February 2011 |
Last Revised Date: March 2012 |
This policy applies to professional and facilities
(hospitals, surgery centers, kidney centers, etc…)
Definitions
Qualitative drug screening tests are used to detect
the presence of a drugs or drug classes in the body. They
provide a positive or negative result rather than specific
measurements of the level of a drug or drugs. Methods
of collecting/testing include, but are not limited
to:
- Cassettes
- Cubes
- Cups
- Dip cards
- Strips
- Swabs
A procedure is defined as a single device or separate
set of reagents, using an instrument, to produce one
or more test results.
Policy Statement
CPT code 80100 (drug screen, qualitative; multiple drug classes chromatographic method, each procedure) is eligible for reimbursement once per procedure and only when a chromatographic method is used for testing.
CPT code 80101 (drug screen, qualitative; single drug class method) is eligible for reimbursement once per procedure. This code is not valid for Medicare members.
CPT code 80104 (Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure) is eligible for reimbursement once per procedure. This code is not valid for Medicare members.
HCPCS code G0431 (drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter) is eligible for reimbursement once per patient encounter.
HCPCS code G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter) is eligible for reimbursement once per patient encounter.
Codes that describe “once per patient encounter” are only eligible for 1 unit of service per patient encounter, regardless of the number of procedures performed.
Codes that describe “per procedure” will be eligible for 1 unit only per date of service. Any appeal will need to be reviewed, with records, to determine if multiple procedures are documented. The only exception is if 80101 is billed by an independent laboratory. In that case, modifier -59 (distinct procedural service) or -91 (repeat clinical diagnostic laboratory test) needs to be appended to the procedure code.
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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