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Thread: Change In G codes for Drug Testing

  1. #1
    Join Date
    Apr 2007

    Default Change In G codes for Drug Testing

    AAPC: Back to School
    I received an article dated 10/08/10 which has at the bottom www.g2reports.com and thought I would share it:

    It states

    “The Centers for Medicare and Medicaid Services (CMS) has posted preliminary payment determinations for new test codes on the 2011 Medicare Part B clinical laboratory fee schedule. The posting follows the public comment period on the codes that ran from July through mid-September (NIR 10, 15/Aug.,pp. 1,2-3).

    As it typically does, CMS opted for the crosswalk method to price most but not all the codes (see table, pp. 4-5). Under this method, a new test code is matched to a similar code on the fee schedule and paid at the lower of the local fee schedule amount or the national fee cap. Most lab codes are paid at the cap.

    For new Current Procedural Terminology (CPT) drug screening code 801XX, CMS made no recommendation. Instead, the agency created a new set of HCPCS G codes for drug screening, depending on the complexity of the test method assigned under the Clinical Laboratory Improvement Amendments (CLIA)---waived, moderate, or high.

    Drug Screening Code Reshuffle
    While acknowledging that the CPT committee created 801XX to replace G0430, Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure, CMS said it has discovered that neither of these codes is properly described in order to control improper payment, billing, and utilization. The agency will delete G0430, edit the descriptor for G0431 to designate use of a CLIA high-complexity test method, and create a new code GXXX1 to indicate use of a waived or moderate-complexity test method.

    Reconderation Requests
    CMS also accepted requests to reconsider the pricing of five codes currently on the lab fee schedule. It agreed to crosswalk and delete one, G0430, as part of the noted switch to a new set of drug screeing codes, based on CLIA complexity. Preliminary crosswalks for the CPT codes under reconderation are:

    G0431, Drug Screen, qualitative; multiple drug classes by high-complexity test method (e.g., immunoassay, enzyme assay), each specimen. To G0430 x 5, or a total of $104.15.

  2. #2
    Join Date
    Apr 2007

  3. #3
    Join Date
    Apr 2007
    Denver Colorado


    FYI: don't hold your breath quite yet regarding Medicare and the G codes for Urine Drug Screen testing in 2011.

    From some industry contacts, I have heard that there is still much discussion going on with Medicare regarding the descriptors for the 2011 G codes. Nothing is really carved in stone until January 1, 2011 at 12:01 AM and even then it could change on March 31st!

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