tci Medicare Compliance & Reimbursement - 2013 Issue 22

Medicare Drug Screen: Don't Expect Medicare To Pay For 80100, 80101, or 80104

Tip: Look to HCPCS codes to get reimbursement. If you’re reporting drug screening tests for Medicare beneficiaries, keep in mind that Medicare won’t accept CPT® drug screen codes 80100, 80101, or 80104. Turn to HCPCS Level II for Medicare Instead, you’ll need to report one of the following codes if a physician orders a drug screen for a Medicare beneficiary: G0431 — Drugscreen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter; G0434 — Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test...

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