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2017 Presumptive Drug Screening Codes

Melissa Posted Tue 10th of January, 2017 09:40:22 AM
do I bill Medicare products with the new codes 80305 through 80307 and all other payers with the G0480 through G0483?
SuperCoder Answered Wed 11th of January, 2017 08:04:20 AM

CPT 80305 through 80307 are Presumptive Urine Drug Testing (UDT).

G0480 through G0483 are Definitive (Qualitative or Quantitative) UDT Testing.

Coding/Billing http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/A59PK51218?OpenDocument

  • Reflex testing for IA presumptive positives may only be performed by laboratories other than physician office labs (POL).  Physicians in POL are expected to determine the medical necessity for definitive testing for a presumptive positive result and document the necessity in the medical record because they have specific patient information and may not need definitive testing.
  • When a presumptive test is negative for a patient on a prescribed medication, a definitive drug test may be performed
  • Only one presumptive service may be billed per patient, per DOS, regardless of the provider
  • Medicare will process the first presumptive service received per patient, per DOS. All subsequent claims for a presumptive service for the same patient and same DOS will be denied.
  • Only one definitive service may be billed per patient, per DOS, regardless of the provider.
  • Medicare will process the first definitive service received per patient, per DOS. All subsequent claims for a definitive service for the same patient and same DOS will be denied.

 

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