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UA screenings


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My question is this:
Do my docs have to own the facility and/or purchase the testing supplies themselves in order to bill for the screening? I'd be billing the 80101 & G0434. It's my understanding that a CLIA Waiver is needed. Do my Docs need to just "order" the screening and the 80101 &/or G0434 can be billed?

Any info is helpful.



True Blue
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"........to monitor for compliance/adherence to the treatment plan or illicit drug use in patients under treatment or seeking treatment for a chronic pain condition."

You would want to check your local Medicare carrier to see if they local coverage determination policy titled such as: Qualitative Drug Testing

As seen above, if the patient seeking or receiving treaatment for chronic pain condition and require opioid analgesic as treatment option for the management of the chronic pain. ICD-9 selection such as post-laminectomy, spinal stenosis or RSD alone does not fully describe the reason for the testing. ICD-9 V58.69 relays the patient is currently using and/or has long term use of opiods. Monitoring patients with urine drug screening can prevent diverison, use of illegal drugs in combination, and used in addition to medication tracking per provider and pharmacy that also another important tool.

For Medicare, G0434 is for reporting a drug test performed with a drug test kit or point of care moderate complexity analyzer. Reimbursement for the testing is at around 20.00. Although this covers the cost using drug test kit, there has been some question regarding whether testing done with an analzer should be grouped in the same reimbursement category, due to the cost of the supplies associated with using this type of instrument. Currently they fall under the same code.

For a non-Medicare carrier, review the below to initially differ 80101 from 80104. 80104 reimburses around 20.00 and is a similar code to G0434. 80101 in contrast is described as an instrument that tests the drug class individually in a single run per class and the cost of performing the testing and the instrument used with be higher and warrant the higher reimbursement.

AMA CPT Changes 2011
Code 80104 has been established to report a specific drug screen, qualitative analysis by multiplexed method for 2-15 drugs or drug classes (eg, multidrug screening kit). The existence of CPT codes and HCPCS Level II codes reportable in 2010 for drug testing created confusion regarding appropriate reporting of qualitative drug screen testing and imposed additional administrative burdens on providers. Code 80104 has been established to report qualitative analysis drug screen by multiplexed method. A cross-reference has been added following code 80101 to direct the user to 80104.



If the location you are at needs a CLIA certificate of waiver, the above link can assist with this. There is a lot to consider such as creating a form that goes over the practices opioid guidelines and agreement, proper documentation to indicate the patient is a qualified individual to receive a UDS and addressing how confirmation testing will be handled if only point of care testing is being performed.


Denver Colorado
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Regardless if diagnostic lab is going to be billed or not, a CLIA certification is required for each office site that is performing the testing. For example, if you have two office locations that will be performing the waived testing, each office will need to get their own CLIA certification

If you are going to be using a cup, cassette, dipstick that is CLIA waived, the code choice is either 80104 x 1 unit of service OR G0434 x 1 unit of service. When billing to Medicare you must also report modifier QW with the G0434 code, report you CLIA certification # in box 23 or the electronic equivalent and indicate the name of the ordering physician and his NPI in box 17 / 17B

You need to be paying fair market value for the lab test kits, i.e. cups, cassettes, dipsticks. Free test kits would be considered a kick-back from the supplier and a very easy way to get in HOT water.