CMS Clarifies Status Indicator Effective Date for 80101

First the Centers for Medicare & Medicaid Services (CMS) said the procedure status indicator change to “Not valid for Medicare purposes” for CPT® code 80101 Drug screen, qualitative; single drug class method was effective April 1, 2010. Then the agency said the effective date was July 1, 2010. And then the Clinical Laboratory Fee Schedule (CLFS) changed the indicator effective date to Jan. 1, 2010. Which is it? A new educational article has been published to clarify the effective date for the procedure status indicator for CPT® code 80101.

CMS issued Sept. 24 a one-time notification (Transmittal 776) to clarify that the effective date for the change of the procedure status indicator to I Not valid for Medicare purposes; Medicare recognizes another code for CPT® code 80101 or 80101-QW –CLIA waived test has been set to Jan. 1 to maintain consistency for all claims.

For claims with service dates on or after Jan. 1, all clinical labs should submit claims with the new test HCPCS Level II code G0431 Drug screen, qualitative; single drug class method or G0431-QW—depending on whether the clinical lab requires a Clinical Laboratory Improvement Act (CLIA) certificate of waiver.

If your practice filed a claim for CPT® 80101 or 80101QW between Jan. 1 and June 30, and it was denied, you should resubmit the claim with HCPCS Level II code G0431 or G0431-QW.

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One Response to “CMS Clarifies Status Indicator Effective Date for 80101”

  1. Jan H says:

    Have they clarified the max units that can be billed ?

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