New coding guidance: CMS proposes new presumptive and definitive drug screen codes, pay in 2017

Why This Topic Matters

The topic matters because changes in lab code sets and payment amounts can affect claim processing, payer adoption timing, and reimbursement planning for practices that perform drug testing in-house.

Article Sections

1. CMS preliminary determinations for the 2017 CLFS

   Overview of the proposed fee schedule update and the public comment process. This section frames the timing and administrative context for the changes.

2. Presumptive drug screen code transition

   Discussion of the planned shift from older Medicare drug screen reporting to newer CPT presumptive drug screen coding. The section addresses the broader transition affecting payer adoption and year-end implementation.

3. Definitive drug screen payment update

   Summary of proposed payment changes affecting definitive drug screening services. It also notes the broader setting in which laboratory stakeholders commented on the proposal.

4. New placeholder code for certain definitive tests

   Introduction of a new placeholder code tied to a specific category of definitive testing and equipment requirements. The section explains the general reason CMS created a separate payment pathway.