Wiki Urine drug test reimbursement

[MLVaughan0986]

Hello,

I was wondering if anyone had any advice that can help my manager get reimbursed for a urine drug test? She is a primary family care APRN. She has used codes 80305, 80306, and 80307. Does anybody know why insurance companies are not covering these codes?

Thank you,

Maggie

 

[Pathos]

The research I made on those codes are as follows (from SelectCoder):

"CMS reminded providers that validity testing is bundled into the drug test in a March 30 MLN Matters article: “Providers performing validity testing on urine specimens utilized for drug testing shall not separately bill the validity testing. For example, if a laboratory performs a urinary pH, specific gravity, creatinine, nitrates, oxidants or other tests to confirm that a urine specimen is not adulterated, this testing is not separately billed.”

Specimen validity testing with drug tests is a long-standing source of confusion for providers. CMS continues to see claims for the service with drug tests and wants it to stop, according to the MLN article. Even though the claim is likely to be denied, providers are more likely to be accused of intentional unbundling because specimen validity testing is included in the descriptors for the eight drug testing codes (80305-80307, G0659 and G0480-G0483)."

Sounds like 80305-80307 are already bundled into other codes.

 

[CodingKing]

I'm pretty sure the NP practice doesn't own equipment that meets criteria for 80306-80307, Only the 80305 is a CLIA waived test. CLIA waiver number must be submitted on the claim.

Most payers follow CMS. link is for CLIA waiver guidelines:
https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Certificate_of_-Waiver_Laboratory_Project.html

Sounds like 80305-80307 are already bundled into other codes.

Those are valid codes. The validity testing is what is bundled into the drug testing codes 80305-80307, G0659 and G0480-G0483.

 

[Pathos]

Those are valid codes. The validity testing is what is bundled into the drug testing codes 80305-80307, G0659 and G0480-G0483.

When I pull up 80305-80307, my report explains that these codes are Statuary Excluded, which per my MAC and CMS explains that these codes may be covered under certain circumstances and not covered under other circumstances:
"For example, under some conditions, a given code may be covered as part of a given benefit, but under other cases when not benefit is applied, the same code would not be covered".

In this circumstance, the validity testing is not covered for 80305-7, which is the point I was trying to make in my original post. However, I see that some clarification was needed, hence this post. We don't commonly use these codes, however as CK explained, they are available for Correct Coding as long as you pay attention to their guidelines.

 

[erjones147]

Since 4/1/2017, I have never NOT gotten an 80305-QW paid for by Medicare when I link the code to Z79.891 (assuming that dx is applicable to the visit)

 

[CodingKing]

When I pull up 80305-80307, my report explains that these codes are Statuary Excluded, which per my MAC and CMS explains that these codes may be covered under certain circumstances and not covered under other circumstances:
"For example, under some conditions, a given code may be covered as part of a given benefit, but under other cases when not benefit is applied, the same code would not be covered".

In this circumstance, the validity testing is not covered for 80305-7, which is the point I was trying to make in my original post. However, I see that some clarification was needed, hence this post. We don't commonly use these codes, however as CK explained, they are available for Correct Coding as long as you pay attention to their guidelines.

Medicare its a little easier since one can consult the LCD for allowed diagnosis codes and number of tests. I think they are just status X since they are paid off the clinical Lab fee schedule and not the physician fee schedule

 

[CodingKing]

Since 4/1/2017, I have never NOT gotten an 80305-QW paid for by Medicare when I link the code to Z79.891 (assuming that dx is applicable to the visit)

Any chance the CLIA waiver number is not listed on the claim? Most of the LCDs I've seen include the DX for long term therapeutic use of Opiates