New coding guidance: Medicare adds a new twist to drug screen coding, keeps 2014 guidelines

Why This Topic Matters

Laboratory drug testing claims can be denied when payers apply different definitions, code sets, or effective-date rules. Understanding the scope of Medicare’s position and how private payer policies may differ helps reduce denials and supports more consistent billing workflows.

Article Sections

1. Medicare’s 2015 drug testing guidance

   Summarizes Medicare’s position on retaining prior-year lab test guidance and the general context of the 2015 clinical laboratory fee schedule. It also notes the relationship between older CPT-based guidance and newly introduced HCPCS coding changes.

2. Examples of differing payer rules

   Describes broad categories of payer variation affecting laboratory drug testing, including specimen considerations, test purpose, and treatment of unspecified test services. The section compares how different payer policies may align with either older or newer guidance.

3. Use denials to determine payer policy

   Explains the operational need to review denials and compare them with billed services in order to identify payer-specific expectations. The section focuses on workflow and documentation practices rather than clinical details.

4. Watch for Medicare policies

   Highlights the importance of monitoring carrier updates and local coverage materials for drug testing claims. It also notes that policy changes may affect whether claims are processed under revised coding structures.