decisionhealth Newsletters, Part B News - 2014 Issue 12 (December)
Medicare issues new drug screen codes, sticks with 2014 payments
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Article Overview
This article explains how Medicare responded to 2015 changes in drug testing coding and payment, and why laboratories and physician offices needed to manage two parallel code sets. It is aimed at coders, billers, laboratory staff, and compliance professionals who report quantitative drug tests, confirmatory testing, and definitive drug testing services. The discussion covers CMS clinical laboratory fee schedule guidance, the shift in CPT drug-screen structure, Medicare’s related HCPCS G-code approach, and the operational impact on ordering, billing, and system updates.
Why This Topic Matters
Drug testing coding changes can affect claim submission, payer-specific reporting, workflow, and EHR/superbill maintenance. Understanding the Medicare approach helps practices avoid mismatched reporting and prepare for different payer requirements.
Article Sections
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Coding
Introduces the coding changes affecting quantitative drug testing and summarizes the need to distinguish between reporting approaches used for Medicare and other payers.
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Different code sets, different requirements
Compares how related drug testing services are reported under the two code families and discusses the operational impact on ordering, billing, and practice systems.
What You Will Learn
- How Medicare responded to the updated drug testing code structure for 2015
- Why laboratories and practices may need to work with more than one code set
- What types of administrative updates may be needed for ordering and billing workflows
- How federal fee schedule guidance affected reporting for drug testing services
Who Should Read This
- Medical coders
- Billing staff
- Clinical laboratory personnel
- Physician office staff
- Compliance professionals
- Revenue cycle managers
Codes Discussed
Code Ranges Discussed
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