# New Drug Testing Codes 2015



## dwaldman

http://www.ama-assn.org/ama/pub/phy...ur-practice/coding-billing-insurance/cpt.page


801XXX1 Drug screen, any number of drug classes from Drug Class List A; any number of non- TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical observation including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges), per date of service 

801XX2A Drug screen, any number of drug classes from Drug Class List A; single drug class method, by instrumented test systems (eg, discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service 

801XX4A Drug screen, presumptive, single drug class from Drug Class List
 B, by immunoassay (eg, ELISA) or non-TLC chromatography without mass spectrometry (eg, GC, HPLC), each procedure 

801XXX6 Drug screen, any number of drug classes, presumptive, single or multiple drug class method; thin layer chromatography procedure(s) (TLC)(eg, acid, neutral, alkaloid plate), per date of service 

801XXX7 not otherwise specified presumptive procedure (eg, TOF, MALDI, LDTD, DESI, DART), each procedure 

Drug Class A 

 Alcohol (Ethanol)  Amphetamines    Barbiturates   Benzodiazepines   Buprenorphine   Cocaine metabolite   Heroin metabolite (6-monoacetylmorphine)   Methadone   Methadone metabolite (EDDP)   Methamphetamine   Methaqualone   Methylenedioxymethamphetamine (MDMA)   Opiates   Oxycodone   Phencyclidine   Propoxyphene   Tetrahydrocannabinol (THC) metabolites (marijuana)    Tricyclic Antidepressants 

Drug Class B 

Acetaminophen Carisoprodol/Meprobamate  Ethyl Glucuronide Fentanyl Ketamine  Meperidine Methylphenidate Nicotine/Cotinine Salicylate Synthetic Cannabinoids Tapentadol  Tramadol Zolpidem Not otherwise specified


----------



## LaVoncye

Im confused I work for a pain management dr. and we do the Preliminary screening in the office and its for multiple panel we test for Narcotics we are CLIA waived. Once we the preliminary the urines are then sent to the outside lab for the final. We are curently using G0434, G0431 and 80104. Will these codes be changing in 2015?


----------



## dwaldman

Yes, it appears the AMA are rolling out some new codes but are not finalized yet. And it is unclear if Medicare will switch over to these codes or stay with the G0434 or G0431 codes.

Their below new code would replace 80104 and would be for a drug test kit/cup for Drug Class List A, which they indicate which codes fall under this selection. 

801XXX1 Drug screen, any number of drug classes from Drug Class List A; any number of non- TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical observation including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges), per date of service 

They have an additional code that appears to replace 80101 as seen below which involves drugs from Drug Class List A

801XX2A Drug screen, any number of drug classes from Drug Class List A; single drug class method, by instrumented test systems (eg, discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service 

Then they have a code for testing done for drugs listed in Drug Class List B

801XX4A Drug screen, presumptive, single drug class from Drug Class List
B, by immunoassay (eg, ELISA) or non-TLC chromatography without mass spectrometry (eg, GC, HPLC), each procedure 

Below is their break out of Drug Class A & B

Drug Class A 

Alcohol (Ethanol) Amphetamines Barbiturates Benzodiazepines Buprenorphine Cocaine metabolite Heroin metabolite (6-monoacetylmorphine) Methadone Methadone metabolite (EDDP) Methamphetamine Methaqualone Methylenedioxymethamphetamine (MDMA) Opiates Oxycodone Phencyclidine Propoxyphene Tetrahydrocannabinol (THC) metabolites (marijuana) Tricyclic Antidepressants 

Drug Class B 

Acetaminophen Carisoprodol/Meprobamate Ethyl Glucuronide Fentanyl Ketamine Meperidine Methylphenidate Nicotine/Cotinine Salicylate Synthetic Cannabinoids Tapentadol Tramadol Zolpidem Not otherwise specified


----------



## tracyalise

Has anyone heard anything about reimbursement for these new codes?


----------



## dwaldman

Presumptive Drug Class Procedures

80300  Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical observation, including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges), per date of service   

80301  Drug screen, any number of drug classes from Drug Class List A; single drug class method, by instrumented test systems (eg, discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay), per date of service    

80302  Drug screen, presumptive, single drug class from Drug Class List B, by immunoassay (eg, ELISA) or non-TLC chromatography without mass spectrometry (eg, GC, HPLC), each procedure80303  Drug screen, any number of drug classes, presumptive, single or multiple drug class method; thin layer chromatography procedure(s) (TLC) (eg, acid, neutral, alkaloid plate), per date of service  

80304  Drug screen, any number of drug classes, presumptive, single or multiple drug class method; not otherwise specified presumptive procedure (eg, TOF, MALDI, LDTD, DESI, DART), each procedure 

Drug Class A 

Alcohol (Ethanol) Amphetamines Barbiturates Benzodiazepines Buprenorphine Cocaine metabolite Heroin metabolite (6-monoacetylmorphine) Methadone Methadone metabolite (EDDP) Methamphetamine Methaqualone Methylenedioxymethamphetamine (MDMA) Opiates Oxycodone Phencyclidine Propoxyphene Tetrahydrocannabinol (THC) metabolites (marijuana) Tricyclic Antidepressants 

Drug Class B 

Acetaminophen Carisoprodol/Meprobamate Ethyl Glucuronide Fentanyl Ketamine Meperidine Methylphenidate Nicotine/Cotinine Salicylate Synthetic Cannabinoids Tapentadol Tramadol Zolpidem Not otherwise specified 

Definitive Drug Class Procedures

80320  Alcohols       
80321  Alcohol biomarkers; 1 or 2    
80322  Alcohol biomarkers; 3 or more 
80323  Alkaloids, not otherwise specified 
80324  Amphetamines; 1 or 2 
80325  Amphetamines; 3 or 4 
80326  Amphetamines; 5 or more 
80327  Anabolic steroids; 1 or 2 
80328  Anabolic steroids; 3 or more
80329  Analgesics, non-opioid; 1 or 2 
80330  Analgesics, non-opioid; 3-5 
80331  Analgesics, non-opioid; 6 or more 1 or 2
80332  Antidepressants, serotonergic class;1 or 2
80333  Antidepressants, serotonergic class; 3-5 
80334  Antidepressants, serotonergic class; 6 or more 
80335  Antidepressants, tricyclic and other cyclicals; 1 or 2 
80336  Antidepressants, tricyclic and other cyclicals; 3-5 
80337  Antidepressants, tricyclic and other cyclicals; 6 or more
80338  Antidepressants, not otherwise specified
80339  Antiepileptics, not otherwise specified; 1-3 
80340  Antiepileptics, not otherwise specified; 4-6 
80341  Antiepileptics, not otherwise specified; 7 or more 
80342  Antipsychotics, not otherwise specified; 1-3 
80343  Antipsychotics, not otherwise specified; 4-6 
80344  Antipsychotics, not otherwise specified; 7 or more 
80345  Barbiturates 
80346  Benzodiazepines; 1-12 
80347  Benzodiazepines; 13 or more 
80348  Buprenorphine
80349  Cannabinoids, natural 
80350  Cannabinoids, synthetic; 1-3 
80351  Cannabinoids, synthetic; 4-6 
80352  Cannabinoids, synthetic; 7 or more 
80353  Cocaine 
80354  Fentanyl 
80355  Gabapentin, non-blood 
80356  Heroin metabolite 
80357  Ketamine and norketamine 
80358  Methadone  
80359  Methylenedioxyamphetamines (MDA, MDEA, MDMA)
80360  Methylphenidate 
80361  Opiates, 1 or more 
80362  Opioids and opiate analogs; 1 or 2 
80363  Opioids and Opiate analogs; 3 or 4 
80364  Opioids and Opiate analogs; 5 or more 
80365  Oxycodone 
80366  Pregabalin 
80367  Propoxyphene 
80368  Sedative hypnotics (non-benzodiazepines) 
80369  Skeletal muscle relaxants; 1 or 2 
80370  Skeletal muscle relaxants; 3 or more 
80371  Stimulants, synthetic
80372  Tapentadol 
80373  Tramadol
80374  Stereoisomer (enantiomer) analysis, single drug class 
80375  Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 1-3
80376  Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 4-6 
80377  Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 7 or more


----------



## dwaldman

G6030 Amitriptyline                 Assay of amitriptyline
G6031 Benzodiazepines           Assay of benzodiazepines
G6032 Desipramine                 Assay of desipramine
G6034 Doxepin                       Assay of doxepin
G6035 Gold                            Assay of gold
G6036Assay of imipramine       Assay of imipramine
G6037 Nortriptyline                 Assay of nortiptyline
G6038 Salicylate                     Assay of salicylate
G6039 Acetaminophen            Assay of acetaminophen
G6040 Alcohol (ethanol); any specimen except breath  Assay of ethanol
G6041 Alkaloids, urine, quantitative  Assay of urine alkaloids
G6042 Amphetamine or methamphetamine Assay of amphetamines
G6043Barbiturates, not elsewhere specified Assay of barbiturates
G6044 Cocaine or metabolite Assay of cocaine


G6045

Dihydrocodeinone

Assay of dihydrocodeinone


G6046

Dihydromorphinone

Assay of dihydromorphinone


G6047

Dihydrotestosterone

Assay of dihydrotestosterone


G6048

Dimethadione

Assay of dimethadione


G6049

Epiandrosterone

Asssay of epiandrosterone


G6050

Ethchlorvynol

Assay of ethchlorvynol


G6051

Flurazepam

Assay of flurazepam


G6052

Meprobamate

Assay of meprobamate


G6053

Methadone

Assay of methadone


G6054

Methsuximide

Assay of methsuximide


G6055

Nicotine

Assay of nicotine


G6056

Opiate(s), drug and metabolites, each procedure

Assay of opiates


G6057

Phenothiazine

Assay of phenothiazine


G6058

Drug confirmation, each procedure

Drug confirmation





G0431

Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter


----------



## dwaldman

Below link has some new HCPCS codes for 2015 and it appears they will retain G0431 and G0434 for 2015 because one of the files in the link states "No Change."

http://www.cms.gov/Medicare/Coding/...CS-Items/2015-Alpha-Numeric-HCPCS-File- .html

G0434	Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter

G0431	Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter


----------



## jgunter

*80375, 80376,80377*

Does anyone have any insight if 80375, 80376,80377 will replace or be in addition to 82541, 82542, 82491, 82492?


----------



## dwaldman

Below is from AMA CPT Changes 2015

"Code 82541 (parent code to codes 85242-85244) has been revised to specify "non drug" analyte in the descriptor. A parenthetical note has been added to direct users to new codes in the drug assay subsection to report column chromatography/mass spectrometry of drugs"

The other codes you mention CPT 82491/82492 would not be separately reported with the new definitive drug testing codes. The clinical example describe these methods being used under the definitive drug testing codes and will not require supplemental codes (82541-82544; 82491-82492) in 2015.


----------



## dwaldman

The below had not been included in this thread. CMS describes delay in pricing for CPT 80300-80377. And the G0431/G0434 on future fee schedule in 2015.


Codes 80300 through 80377 (63 codes) 
Industry Recommendation:  Various, from crosswalking to specific existing codes (e.g., G0434, G0431, etc.), to gap filling. 

CMS Recommendation:  Delay in pricing. 

Rationale:  These codes represent various drug screening codes, many of which are specific to individual drug testing.  While we appreciate the recommendations for these tests, we are concerned about the potential for overpayment when billing for each individual drug test rather than a single code that pays the same regardless of the number of drugs that are being tested for.  Therefore, it is our recommendation to delay pricing for these codes at this time, until further information and education is obtained.


----------



## suemt

Thanks for the link to the HCPCS coding.  I also see in the table all the new G-codes have this value in the BETOS field:

T1H = Lab tests - other (non-Medicare fee schedule) as opposed to:

T1G = Lab tests - other (Medicare fee schedule)

This further confirms these new codes will not be payable by Medicare and we should continue to bill with G0434 and G0431.


----------



## Sbrooks225

For our laboratory, the insurance companies have been denying payment of the new drug codes.  I am having an issue with 80323 Alkaloids, not otherwise specified- its being denied for reason"the unlisted code is disallowed because a description of the service is required but was not received.  But if you call the insurance company they will resubmit the code for reprocessing.


----------



## cbishop

Can someone tell me if they are billing multiple units of the gcodes to Medicare other than G6056 that states each procedure? 

Thanks


----------



## suemt

If you check out the MUE file, it tells you the maximum number of units Medicare will pay.  

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html



cbishop said:


> Can someone tell me if they are billing multiple units of the gcodes to Medicare other than G6056 that states each procedure?
> 
> Thanks


----------

