CMS Drug Testing Codes for 2016

CMS Drug Testing Codes for 2016

The Centers for Medicare and Medicaid Services (CMS) currently does not recognize AMA CPT® drug testing codes (80300-80377). Rather, Medicare payers require that you submit claims for drug testing with dedicated HCPCS “G” codes. For 2016, CMS deleted definitive drug testing codes G6030-G6058 and replaced them with a handful of new codes:

G0477 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg immunoassay) capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.

G0478 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg immunoassay) read by instrument-assisted direct optical observation (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.

G0479 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers (eg, immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service.

G0480 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or 13 tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed.

G0481 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed.

G0482 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed.)

G0483 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed.

The codes differentiate between presumptive testing (is a drug present?) and definitive testing (to provide a positive identification of the substance in question).

When reporting services, report only one of the three presumptive G codes, per day. Similarly, you may report only a single definitive G codes, per day.

For definitive testing, the unit used to determine the appropriate definitive G code to bill is “drug class.” CPT® defined drug classes include:

  • Alcohol(s)
  • Alcohol Biomarkers
  • Alkaloids, not otherwise Specified
  • Amphetamines
  • Anabolic steroids
  • Analgesics, non-opioid
  • Antidepressants, serotonergic class
  • Antidepressants, Tricyclic and other cyclicals
  • Antidepressants, not otherwise specified
  • Antiepileptics, not otherwise specified
  • Antipsychotics, not otherwise specified
  • Barbiturates
  • Benzodiazepines
  • Buprenorphine
  • Cannabinoids, natural
  • Cannabinoids, synthetic
  • Cocaine
  • Fentanyls
  • Gabapentin, non-blood
  • Heroin metabolite
  • Ketamine and Norketamine
  • Methadone
  • Methylenedioxyamphetamines
  • Methylphenidate
  • Opiates
  • Opioids and opiate analogs
  • Oxycodone
  • Phencyclidine
  • Pregabalin
  • Propoxyphene
  • Sedative Hypnotics (nonbenzodiazepines)
  • Skeletal muscle relaxants
  • Stereoisomer (enantiomer) analysis
  • Stimulants, synthetic
  • Tapentadol
  • Tramadol
  • Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified;

Each drug class may only be used once per day.

dec-clearance-sale

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 402 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

31 Responses to “CMS Drug Testing Codes for 2016”

  1. J smith says:

    Change Request 9459 does not list this codeset G0477-G0482 as being added as new CPT/HCPCs. Are other providers receiving edits when sending these codes?

  2. Pam chastain says:

    What code replaced G0431?

  3. sarbiller says:

    All of my claims using the new G0477 code have been rejected. Does anyone know what is going on?

  4. Jade S. says:

    Bueller?? We are getting rejections from Humana for G0434 and 60431. We are going to try G0477, but don’t have a code replacement for G0431. Any sugggestions?

  5. L Caporino says:

    Although they changed the code effective 1/1/16, they didn’t put it into effect until February. However, it is now being rejected with the QW modifier.

  6. Shellie says:

    Mine are being rejected for C04 inconsistent with modifier used or a required modifier is missing …I used mode QW

  7. Alice Jaramillo says:

    It is my understanding that these G codes (G0477-G0843) are not in effect until 4/4/16.

  8. RR says:

    @ Sarbiller says: This is from CMS website:
    Claims, Pricers, and Codes

    New Drug Testing Laboratory Codes Editing Incorrectly

    CMS discovered systems errors affecting claims with new drug testing laboratory codes (HCPCS codes G0477 through G0483) with dates of service on or after January 1, 2016. Your Medicare Administrative Contractor (MAC) will be holding these claims until April 4, 2016. No provider action is required. However, should you wish to avoid your claims from being held, you can remove codes G0477 through G0483 and submit the rest of the services on the claim. When the system is updated in April, you can submit an adjustment claim to add these HCPCS codes. Your MAC will correct any claims previously returned to you in error with these codes and reason code W7006 after the system is updated.

  9. Britney Kelly says:

    Has anyone been able to get paid for G0477? I have been getting denials with and without the QW modifier.

  10. Manish Kumar says:

    For screening we need to use G0479.

  11. ASaiz says:

    Thank you for your comment. You’ll find a lot of suggestions and better answers to your question in the Member Forums.

  12. ASaiz says:

    Thank you for your comment. You’ll find a lot of suggestions and better answers to your question in the Member Forums.

  13. Charlie says:

    Medicaid is denying CPT G0483 as not a listed procedure code. What is the code that we can bill with? Can some one suggest me Please.

  14. Pk212 says:

    Is these G codes are only for Medicare or we can bill to all other commercial payers?

  15. JT0989 says:

    Has anyone been getting paid for G0478 yet? I’ve resubmitted G0477 then resubmitted my claims with G0478 with the QW modifier and still they are being rejected. Has the system not been updated yet?

  16. Kristen Kroflich says:

    For G0479, can I bill this (per visit) for each substance tested in a urine screen (such as if testing for 10 substances–can I code/bill this code 10 times)? Or just bill the code one time?

  17. debra may says:

    medicare is denying all of our g0479 with dx code z0283 and no modifier…help!!!

  18. Mike says:

    Medicare has started paying for G0477 and has correct to the first of 2016. Humana is still denying G0477 and will not provide an answer as to why they will not pay. Has anyone had any luck as of 7-23-2016?

  19. Judith Faustin says:

    How many times per week can you bill G0479

  20. Renee says:

    Medicare has started paying for G0477 and has correct to the first of 2016. Humana is still denying G0477 and will not provide an answer as to why they will not pay. Has anyone had any luck as of 7-23-2016?
    ITS NOW 08/29/2016
    LUCK ANYONE ?
    Thanks

  21. Sonny D says:

    G0482 denied by Medicare , Please help

  22. Mike says:

    Renee, I still have not found out why Humana will not pay for G0477. I have appealed with no luck. If anyone knows the answer please speak up. Thanks

  23. Stephanie says:

    I’m billing mental health I put in g0477 with AF mofifier… for my urine drug screens is that wrong? Please help!!!.. please reach me T my email address below and helpppl!!

  24. Randi says:

    what is the approved dx code for G0479? We used F31.9 and it was denied??

  25. Rita Janes says:

    Do you have the QW modifier on the code G0477? The only diagnosis they will pay for is Z79.899 Medication therapy.

  26. Suzi says:

    Humana continues to not follow Medicare guidelines as is still denying all my G0477 codes with and without the modifier and with an appeal with medical records, they still are not paying. Medicare has paid with no problem and all other payors. Per call to Humana several times and have received zero help. Has anyone found an answer or a code as of Oct 11, 2016 that Humana does recognize instead of the G0477? It’s really ridiculous dealing with Humana.

  27. Michelle Simien says:

    i am having trouble billing medicare….plz help…I know you suppose to bill with G codes when you dealing with drug screening, but why am I getting denied…

  28. Laura says:

    Stephanie, try QW modifier.

  29. Sandra Rivera says:

    Medicare have denied all our claims for HCPCS G0478 with or without QW modifier. Please help!!!! It is impossible to get any answers when i contacted Medicare.

  30. Brad Ericson says:

    Hi Sandra,

    Try posting this question on our member forum. Your colleagues should be able to help you there.

  31. alma says:

    PLease read the final determination for CMS. Medicare is not paying for any drug screen no matter what the code is. G codes nor 8000 cpt series. only payable by other ins if its independent lab. Only dip stick, urine cup allowed for payment .

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