Does CMS accept drug screening HCPCS codes?

April 6, 2016
Medicare Web

Q: Did CMS ever add the drug screening HCPCS codes to the system so we can process these claims?

A: HCPCS codes G0477–G0483 (drug testing, presumptive or definitive) were released too late last year to be included in the January 2016 update to the I/OCE. There was discussion on the Hospital Open Door Forum call and CMS published guidance on how to handle these codes until they could be added to the I/OCE. The options were that the Medicare Administrative Contractor would hold the claims until the April I/OCE update or, if providers needed to avoid having claims held, the codes could be removed and the remainder of the claim submitted. CMS noted that providers can submit an adjustment claim to add these HCPCS codes.

Transmittal 3471 confirms that these codes are included in the April I/OCE and will be processed beginning with that update. These codes are all assigned to status indicator Q4 (conditionally packaged laboratory tests) under the OPPS.

Each provider should consider how to handle the adjustment claims for the claims which had these codes removed. The first thought for some will be that “It doesn’t matter because there is no payment related to these codes.” That is a true statement–there is no line item payment attached to these codes when billed with other OPPS services. However, the volume of these codes can be quite high, especially when you consider the frequency of these codes being reported, for example, in the ED. One concern here is that if the adjustment claims are not submitted, the cost of caring for the individual patient is understated. That doesn’t seem very important when you think of one patient. However, think about it across your Medicare patient population, and then consider that across all OPPS providers. This situation affects a very large number of claims across OPPS providers, and will play a part in future ratesetting under the OPPS. The data becomes more and more important as CMS moves forward to more bundled/packaged payments for encounters.  

Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.

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