decisionhealth Newsletters, Coder Pink Sheets - 2015 Issue 2 (February)
Medicare issues new drug screen codes, sticks with 2014 payments
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Article Overview
This article explains how changes to laboratory drug testing coding affected Medicare and other payers, with a focus on the 2015 clinical laboratory fee schedule and the split between CPT and HCPCS reporting. It is aimed at laboratories, coders, billing staff, and practices that order or perform quantitative drug testing and need to understand the evolving code structure, payer differences, and operational impacts on ordering, billing, and system updates.
Why This Topic Matters
Drug testing coding changes can affect claim submission, payer routing, and workflow across laboratories and physician practices. Understanding which code set applies for Medicare versus other payers helps reduce billing errors and prepares systems for updated laboratory reporting requirements.
Article Sections
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Medicare and CPT changes for drug testing
Introduces the shift in drug testing code structure and explains the broader payer impact. Covers the 2015 Medicare fee schedule context and the relationship between CPT and HCPCS reporting.
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Different code sets, different requirements
Describes how different payer systems affect reporting for drug testing services. Discusses the operational challenges of using separate code sets for similar laboratory services.
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Official Resources
Lists external CMS reference documents related to the 2015 clinical laboratory fee schedule. Includes source links for preliminary and final determinations.
What You Will Learn
- How Medicare’s approach differed from the revised CPT drug testing structure
- Why laboratories and practices needed to manage more than one coding framework
- What operational areas may need updates when drug testing codes change
- Which CMS fee schedule documents are referenced as primary resources
Who Should Read This
- Medical coders
- Laboratory billing staff
- Compliance staff
- Physician office staff
- Reference laboratories
- Health information management professionals
Codes Discussed
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