Wiki ABN forms

[heathercompton1988@yahoo.com]

With all of the changes in pain medicine management, our practice will start billing for the urine drug screens (80305). CMS does not currently pay for this so we are considering having the patient's sign an ABN form to cover the cost of the cup. Is anyone in the same situation? The LCD is vague on CPT code 80305, we interpreted it to mean that it is reasonable and necessary but CMS allows $0.00 on their fee schedule. Are we able to charge the patient with an ABN form if CMS considers it reasonable and necessary?

 

[Kentuckygirl1984]

I work in pain management as well Per 2017 CMS Clinical Lab fee schedule on the cms website medicare does cover the code 80305 with reimbursement of $14.96. Hope this helps for you.

 

[heathercompton1988@yahoo.com]

Is that for labs only? We are a specialists office and were told it is not paid in the office setting. Thanks!

 

[CodingKing]

I'd send them to a lab if its not paid for the office setting. I don't believe an ABN would be appropriate in this situation where it's a covered benefit.

 

[thomas7331]

Medicare will pay for the lab done in a physician office if you have the required level of CLIA certification. Clinical lab services are not paid on the physician fee schedule - I'm guess that's where you're looking which might be why you're seeing a $0 allowable - you'll need to access the Clinical Laboratory Fee Schedule Files on the CMS to get the current allowable for this code. I agree with the last post that an ABN would not be appropriate if the lab is a covered benefit that would otherwise be paid.