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Drug Screen CPT and HCPCS Codes

Pam Posted Fri 30th of January, 2015 16:49:03 PM

1. We are getting denials from Medicare for billing CPT code 80302
(drug screen, presumptive single drug class from drug class list
B). Should we be using HCPCS code G0431 instead of 80302?

2. Are the new drug testing/assay HCPCS codes G6030 thru G6058 to be
used for drug testing confirmation only?

SuperCoder Answered Mon 02nd of February, 2015 10:39:07 AM

Thank you for your question.

Depending on the denial reason, Medicare prefers G0431 in the following scenarios:

Medicare and some commercial payers require G0431 for providers with high complexity CLIA certified labs that perform drug screen testing with a high complexity method. The maximum units of service would be 1.

Medicare and some commercial payers require G0434 for providers with either moderate complexity or CLIA waived certified labs that perform drug screen tests. Append modifier QW, CLIA waived test when a CLIA waived lab is performing a CLIA waived test.

Yes, G6030 through G6058 are for drug confirmation.

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