This is what we got from a reference company we use.
What You Need to Know
Drug Screening Codes
Following are the current definitions of all test codes addressed in MLN Matters SE101:
CPT® Code 80100 – Drug screen, qualitative; multiple drug classes chromatographic method, each procedure
G0430 – Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure
CPT® Code 80101 – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class
CPT® Code 80101QW – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class
G0431 – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class
Multiple Drug Class Methods
MLN Matters SE101 provides the following billing instructions for the period of January 1, 2010 through March 31, 2010:
Chromatographic Method: When performing a qualitative drug screening test for multiple drug classes using chromatographic methods, CPT® Code 80100 is the appropriate code to bill.
Other Methods: When performing a qualitative drug screening test for multiple drug classes that does not use chromatographic methods, new test code G0430 is the appropriate code to bill.
Single Drug Class Methods
MLN Matters SE101 provides the following billing instructions for the period of January 1, 2010 through March 31, 2010:
Laboratories Holding Moderate or High Complexity CLIA Certificates: When performing a qualitative drug screening test for a single class of drugs, regardless of the testing methodology, those clinical laboratories that do not require a CLIA certificate of waiver should bill new test code G0431.
Laboratories Holding CLIA Waiver Certificates (labs that perform only waived tests): Those clinical laboratories that do require a CLIA certificate of waiver should continue to utilize CPT® Code 80101QW.
Action Needed
Be sure laboratory and billing staff are aware of these billing instructions.
Effective Date
01 January 2010
Background
N/A
Reference
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1001.pdf
What You Need to Know
Effective January 1, 2010, two new G-codes (G0430 and G0431) were added by CMS to keep pace with the newer drug screen technologies. The new G codes distinguish between a multi-drug immunoassay method (G0430) and an immunoassay method covering single drug classes (G0431). In the 2010 OPPS Final Rule, published in the November 20, 2009 Federal Register, the CPT® drug screen codes 80100 and 80101 were listed with status indicator “E”. Recently, CMS released an updated Addendum B in which these codes were listed with status indicator “A”. When this change occurred there was widespread confusion among physician office and hospital labs concerning the appropriate use of codes 80100, 80101, G0430 and G0431 for drug screen testing. Craneware contacted CMS and received the following verbal guidance. According to the spokesperson at CMS, the agency will release further written authoritative guidance about how to bill for these tests in a future Medlearn Matters article. The following is a summary of verbal guidance provided by the CMS spokesperson:
• 80100 - Drug screen, qualitative; multiple drug classes chromatographic method, each procedure.
• 80101 - Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class.
• G0430 – Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure.
• G0431 – Drug screen, qualitative; single drug class method (e.g. immunoassay, enzyme assay), each drug class.
CMS stated that:
• CPT® 80100 will remain in effect in 2010 and G0430 will not replace it as this new G code has a different description.
o CPT® 80100 will continue to be used for the chromatographic method used to detect multiple drug classes simultaneously.
• CPT® 80101 is directly replaced with G0431, therefore CPT® 80101 will be changed back to “non-covered” as of April 1, 2010.
• G0430QW and G0431QW will be created for the CLIA waived laboratories.
• As of April 1, 2010 the following will be the only active codes:
o 80100
o G0430 and G0430QW
o G0431 and G0431QW
The CMS representative did not specifically comment on the use of the old codes 80101 and 80101QW between now and April 1, 2010. It appears these codes will continue to exist thourgh March 31, 2010. Facilities may use the G0431 now to alleviate conversion issues in April.
Action Needed
The laboratory and chargemaster staff should review the above CMS verbal instructions and pay close attention to the forthcoming Medlearn Matters article. Once a decision is made as to the facility’s preference for coding between January 1 and March 31 for CPT® 80101 versus G0431, then the chargemaster should be updated accordingly. We caution readers that this information is based on verbal communication with CMS and does not have the weight of authority. Providers should reaffirm this information with future written documentation from CMS and/or Medlearn Matters.
Effective Date
01 January 2010
Background
2010 OPPS Final Rule - Appendix B 2010 Laboratory Fee Schedule Final Payment Determinations
Reference
http://www.cms.hhs.gov/ClinicalLabFeeSched/Downloads/Calendar_Year_2010_rationale.pdf
see if any of this helps.