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CPT codes 80101 versus 80104

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    We have billed the 80104 * the number of units and were denied with a major commercial carrier saying it is bundled??? do these need modifiers or need to be on seperate lines?

  2. #22
    Would report 80104 with one unit. The code represents multiple drug classes being tested in a single procedure thru a drug test kit that tests the drugs simulaneously. It is not the same as the single class methodlogy of reporting as seen with 80101 which is performed on an instrument that is testing as a single run per drug class.

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    Thank you for this discussion. We are using the CLIAwaived multiple drug cup test. It says it is an "immunochromatographic assay for rapid qualiative detection of drug combinations..." We were told to bill G0434QW x 1 to Medicare and 80101QW x 10 to all other carriers. I agree with the G0434 x 1 to Medicare, but think that 80104QW x 1 is a better code that describes this drug screen. This is a HUGE argument in our office. I am just looking for some confirmation.

  4. #24
    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. Code 80104 appears with a number symbol () to indicate that this code appears out of numerical sequence...

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    Above is from the AMA on reporting a UDS performed utiziling a drug screening kit. This would be an official source for coding guidance. You have look at what is realistic if you are billing Medicare with G0434 and receiving around 20.00 to cover the cost of the drug test kit. It would seem that if 80104 has a similiar reimbursement, 80104 would also represent the resources used. And per the AMA, 80104 was established for drug test thru a drug test kit.

    80101 x 10 at 15 to 20 dollars a drug class would represent resources that are seen with a an instrument that can withstand repeat use, performs single runs per class, confirmation testing available for the specimen, and higher cost to perform the test across the board regarding qualified staff to perform the testing and manage quality of the testing, cost of the instrument/supplies, service contract and other costs to maintain the higher level of testing.

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