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Thread: Chronic Pain Clinic- Brand New- PLEASE HELP

  1. #1

    Question Chronic Pain Clinic- Brand New- PLEASE HELP

    AAPC: Back to School
    The company that I work for is an anesthesia billing company. We are taking on a new client that will be a chronic pain provider. He will have his own office that he provides services out of. When a new patient comes into the office he will be performing a drug test & the screening right there in the office. Also when a patient that recieves pain management routinly the provider will be repeating the screening each time.

    This provider does not have a CLIA certificate, but rather a CLIA waiver. We need to know what codes would be used for the collection of the specimen, what code would be used for the screening, and what code for the repeat test and screening when the patient is not concidered a new patient.

    Any help or guidence is VERY MUCH APPRECIATED!!!!! Thank you in advance!! :-)

  2. #2


    You can use 80101 with a QW modifier for the drug screen if they're doing a urine dip. You would bill this for each class of drug tested. This code is only valid for MC until 4/1/10 at which time you have to start using the HCPCS codes G0430 and G0431. My understanding is that MC is supposed to release new guidance on April 1st regarding billing the G codes.

  3. #3
    Join Date
    Apr 2007
    St. Joseph County, Indiana


    There is quite a lot of controversy and confusion regardind the new way to bill for drug screens. Go to the pathology/laboratory section of the coding forum. I have a few long discussions related to 80101 and G0431 from February and March. It's not a simple answer.

  4. #4


    Here is the link to the CMS manual update effective 4/1/10


  5. #5


    Thank for all of your help!!!! We really appreciate it!!!

  6. #6
    Join Date
    Apr 2007



    G0430 under this code in the above link Medicare lists all drug screens that test for multiple drug classes

    G0431 under this code they list tests like the Quickscreen One Step Opiate Screening test. This test and other tests listed under G0431 are only testing for one drug class.

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