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80101 vs 80104

  1. #1
    Default 80101 vs 80104
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    Where is it in writing,other than Medicare, how to use 80101 vs 80104. I think we should use 80104 not 80101. (I thought I read somewhere that 80101 is a high complex test), any help is greatly appreciated

  2. #2
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    Anyone?

  3. #3
    Location
    Bay City, Michigan
    Posts
    21
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    Hello,

    The LCD from Medicare L28145 gives you the definition of the Codes. Medicare has replaced using 80101 with G0431.

  4. #4
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    Quote Originally Posted by pw18881 View Post
    Where is it in writing,other than Medicare, how to use 80101 vs 80104. I think we should use 80104 not 80101. (I thought I read somewhere that 80101 is a high complex test), any help is greatly appreciated
    80101 Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class (This test may be requested as a drug screen for a single drug class)
    80104 Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure.(This test may be requested as drug screens for multiple drug classes)

    In 80104, a number of different methods are available to screen for qualitative, non-chromatographic, multiple drug class assays, including multiplexed screening kits, urine cups, test cards, or test strips. Positive tests are always confirmed with a second method.

  5. #5
    Location
    St. Joseph County, Indiana
    Posts
    101
    Default
    This may be a little late, but....

    For commercial carriers, the 80101 is only acceptable if you are moderately complex (have a table top analyzer in your office) or highly complex.

    The 80104 is appropriate for this $5 point of service tests.

    I have never seen a commercial policy to either code from Anthem BC/BS, BC/BS of Michigan, Aetna, UHC, etc...but don't use this as a rationale to billed 80101 x 12 for a point-of-service test. These tests are under tremendous scrutiny these days. Don't wreck it for the rest of us.

    Brock Berta
    Billing Czar

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