CMS to providers: Pay attention to correct coding and billing for drug testing

April 11, 2018
Medicare Web

CMS reminded organizations to pay attention to billing and coding for specimen validity testing done in conjunction with drug testing. The agency reviewed recent code changes and billing guidelines for these lab tests in Special Edition MLN Matters 18001 released on March 29. CMS emphasized that providers that perform validity testing on urine specimens cannot separately bill the validity testing.

Coding for drug testing is based on a specific structure of lab tests: a screening or presumptive test and a quantitative or definitive test that identifies the specific drug and quantity of drug in the specimen. Presumptive drug testing is reported with CPT® codes 80305-80307 based on the test’s level of complexity. Providers can report only one presumptive code per date of service. Definitive testing is reported with HCPCS codes G0480-G0483 based on the number of drug classes including metabolites tested. Only one definitive code per date of service can be reported. An additional HCPCS code, G0659, was created for laboratories that perform less sophisticated versions of definitive testing than is performed in drug testing laboratories.

Drug testing claims are likely to come under greater scrutiny. A recent Office of Inspector General report found that Medicare handed out $66 million in improper payments for specimen validity billed with urine drug tests. Providers should review lab coding and billing to ensure CMS’ guidelines are followed and be aware of the possibility of future audits focusing on lab billing compliance.