Wiki Help with 2015 Drug Screen codes!

[AimeeA10]

Hi - I am wondering if anyone can offer some guidance on how to bill for some of our LCMS definitive drug testing. Our practice falls under Cahaba's jurisdiction for Medicare.

I am struggling to choose the correct code to bill for Medicare when we test for THC, Soma (Carisoprodol), Gabapentin, Pregabalin, Propoxyphene, and Tramadol. Medicare did not create a G code for these and according to the draft policy that Cahaba has on their website, they consider G6058 (Drug Confirmation, each procedure) to be for qualitative testing and our machine is quantitative.

I am searching high and low for any information. Any help or advice will be greatly appreciated.

Thanks!

 

[moore509]

Look into G0431 and G0434

 

[AimeeA10]

Look into G0431 and G0434

Thank you for your input but our machine is liquid chromatography with mass spectometry so it does not fall into the category for G0434 and G0431 because it is not a screen and it does not produce qualitative results. It gives a definitive quantitative result. We currently bill G0431 for our immunoassay machine that gives a qualitative result.

 

[suemt]

I was having the same problem with NGS. I submitted a formal request to them and received a letter dated 5/4/15 that says "Currently NGS does not have an LCD for Quantitative drug screening. Some contractors have begun drafting policies. If NGS writes a coverage policy for Quantitative drug screening it will be posted on www.ngsmedicare.com. Please keep an eye on the website for any upcoming changes."

To see an example of a MAC that HAS put together a policy, see Palmetto. http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Jurisdiction-11-Part-B~9SDPFR2173

Very comprehensive, but there are special software/transaction requirements that won't apply to any other jurisdiction.

Will keep keeping an eye out for this myself, as several of my clients are impacted.