Will CPT® 2017 Settle Drug-Screen Coding Once and For All?

drug screen CPT 2017 update

Coding for drug screening certainly keeps you sharp. Along with all the CPT® codes and rules, you’ve got to remember that Medicare requires use of a separate set of HCPCS codes in 2016. But you may find things a little simpler in 2017.

Add CPT® Codes That Are HCPCS Lookalikes

CPT® 2017 deletes presumptive drug class screening codes 80300-80304. A note in CPT® 2017 says to look instead to new codes 80305-80307.

The new codes’ descriptors look almost identical to the HCPCS codes Medicare required you to use in 2016, G0477-G0479. The plan is to delete the HCPCS codes and use the CPT® codes for Medicare.

For the Clinical Lab Fee Schedule (CLFS), the expectation is that the pricing for the new 2017 codes will be similar to the pricing of their 2016 HCPCS counterparts.

You’ll want to check HCPCS 2017 and the final CLFS when they’re released to be sure all of these proposals get finalized, of course.

Here’s a rundown of the new codes. Note that just like the HCPCS codes you’ve been using, the CPT® descriptors specify that:

  • The codes include sample validation (such as pH, specific gravity, and nitrite) if performed
  • The codes apply once per date of service.

Apply 80305 for Direct Optical Observation

When the analyst visually reads the results of the test, you’ll use 80305 (Drug test[s], presumptive, any number of drug classes, any number of devices or procedures [e.g., immunoassay]; capable of being read by direct optical observation only [e.g., dipsticks, cups, cards, cartridges] includes sample validation when performed, per date of service).

Code 80305 replaces G0477.

Choose 80306 for Instrument Assist

When the analyst uses an instrument to help determine the results of a direct optical observation test, then you’ll report 80306 (… read by instrument assisted direct optical observation [e.g., dipsticks, cups, cards, cartridges], includes sample validation when performed, per date of service).

So, for example, if the analyst inserts a dipstick into an instrument to get the final result, you’ll use 80306.

This code resembles current code G0478.

Select 80307 for Instrumented Chemistry Analyzer

The final code in the new group is appropriate when the analyst uses any of a large number of methods requiring instrument chemistry analyzers. The code is 80307 (Drug test[s], presumptive, any number of drug classes, any number of devices or procedures, by instrument chemistry analyzers [e.g., utilizing immunoassay (e.g., EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA)], chromatography [e.g., GC, HPLC], and mass spectrometry either with or without chromatography, [e.g., DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF] includes sample validation when performed, per date of service).

Code 80307 is modeled on G0479, but the list of examples is more extensive in 80307’s descriptor.

The CPT® guidelines explain that some of the methodologies listed in the example are also in use for definitive drug testing. The presumptive method, however, does not definitively identify the drug.

Here’s Where You’ll Find the New Codes

In your CPT® manual, you’ll notice that the presumptive Drug Class Screening and Definitive Drug Testing codes continue to remain out of numerical order in the lab section of CPT®. Each code is marked with # to indicate the code is placed in the section based on the nature of the service rather than being in numerical order.

The codes come after Organ or Disease-Oriented Panels code 80076 and before Therapeutic Drug Assays code 80150.

How About You?

Are you a lab coder? Do you think these changes will finally bring some stability to coding for drug screening?

For in-depth, expert analysis of the changes coming for this unique specialty, be sure to check out Pathology/Lab Coding Alert, included in SuperCoder’s Pathology/Lab Coder.

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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58 Comments For This Post

  1. Joan Stark Says:

    Do you know or have a counterpart who is knowledgeable about G0479 and 80307? Is there another G code for 80307? United Healthcare Insurance Companies are denying 80307 saying it is not valid and asking for another G code. Is it possible it needs a modifier, and, if so. would you know? Thank you.

  2. Deborah Marsh Says:

    Hi, Joan – My first thought is that it’s possible UHC hasn’t applied the corrections document for HCPCS 2017, which deletes G0479 (http://blog.supercoder.com/my-skill-sharpener/have-you-checked-the-hcpcs-corrections-file-lab-coders-im-looking-at-you/). I’ll check in with the team, and if I find something more definitive, I’ll post again (and I hope any other readers with information will comment to let us know!).

  3. Jill Winkelman Says:

    Kareo states that the diagnosis code Z79.899 is not valid for 80305. That is the code I used for G0477. Any suggestions on what diagnosis code to use? Thanks!

  4. jackie Says:

    Hello, I am also having the same information provided by UHC. They only want G-codes again in 2017…

  5. esther cribe Says:

    This was approved 11/9/2016, I haven’t seen any new updated 2017 codes
    How about Medicare/Medicaid anyone new what they’re cpt and icd 10 codes are?
    Clarification: For ICD-10 diagnosis codes, see related Local Coverage Determinations.
    HCPCS Code Description
    G0477
    Drug test(s), presumptive, any number of drug classes; any number of devices or
    procedures, (e.g., immunoassay) capable of being read by direct optical observation
    only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when
    performed, per date of service (New code effective 01/01/2016)
    G0478
    Drug test(s), presumptive, any number of drug classes; any number of devices or
    procedures, (e.g., immunoassay) read by instrument-assisted direct optical
    observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when
    performed, per date of service (New code effective 01/01/2016)
    G0479
    Drug test(s), presumptive, any number of drug classes; any number of devices or
    procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme
    assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes
    sample validation when performed, per date of service (New co

  6. Juanita Says:

    Our office is also experiencing the same problem with United Healthcare. They are directing me to the Laboratory Service Policy 2017R0010A, which does state “Consistent with CMS, Drug Assay CPT codes 80305-80377 are considered non-reimbursable. These services may be reported under an appropriate HCPCS code.”, this is true for 2016, should not hold true for 2017. I have been on the phone with multiple representatives and have gotten nowhere. I tried to explain CPT code 80307 is a CMS and AMA reimbursable code as of 01/01/2017 but they cannot comprehend and just resort back to the Policy that they state is still effective although the annual approval date is 03/09/2016.

  7. hannah Says:

    We have cases where Alcohol, Salicylate and Acetaminophen are ordered are ordered at one Date of Service.All 3 will use cpt 80307. Can we use a modifier -59 to bill the three individually?Or can we only bill once?

  8. Deborah Marsh Says:

    Hi, Hannah – CPT® guidelines state, “Report 80307 once, irrespective of the number of drug class procedures or results on any date of service.” Hope that helps!

  9. Ashley Says:

    Hello everyone!
    I literally just got off the phone with Medicare Part B (for TX) because I am having the same issues as you all are having- denials as not covered/invalid CPT. Medicare rep informed me that the 80305 does require the QW modifier, but there system shows the implantation date for the change is not until 4/1/17. Therefore, they will not be paying on any claims until 4/1/17, they told me to hold my claims. Yes, you will still use 80305 starting from 1/1/17, but do not send the claims until 4/1/17. This is an issue for our lovely 90 day timely insurances that follow medicare. What I am doing is making sure to get a denial at least for the January claims (that way I do not get timely denial) then I will have the extended time to correct claim/have them reprocessed. I hope this helps everyone!!

  10. Deborah Marsh Says:

    Thanks for the information, Ashley! There’s an MLN Matters article that lines up with what the rep said about the date mismatch:
    MM9956 – New Waived Tests
    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9956.pdf

    I really appreciate everyone sharing!

  11. Devona Slater Says:

    For Medicare claims, should the QW modifier apply to 80307?
    Thanks for your guidance

  12. Deborah Marsh Says:

    Hi, Devona – It doesn’t look like QW applies to 80307. The current CLIA-waived list of tests shows G0477 (which 80305 replaces) with QW, but it does not include G0479 or the code that replaces it, 80307, likely because of the test complexity. Similarly, the instruction from CMS showing that G0477QW is being replaced by 80305QW does not refer to either G0479 or 80307 with QW (https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3696CP.pdf). Hope that helps!

  13. Zahid Latif Says:

    Hi, now what is the resolution as 80307 is denied by UHC non covered charges. and Aetna, Aenta Better Health, UHC community plan and Medical mutual also denied 80307 stating that this is not reimbursable code.Every insurance said we can appeal on this denial and i think so it is not proper reslution. Any one have resolution on this issue?

    Thank you.

  14. Wanda Bailey Says:

    Has anyone found out if UHC is still using G0479 and not 80307?

  15. Kayla Sexton Says:

    Has anyone found a resolution to the UHC denial of the code 80307. I have spoken to many representatives an they each give a the same that it is not covered under the patients benefits plan an that it would be considered behavior health when using the icd code z79.899

  16. Omar Faruk Says:

    Can anyone tell me if CPT 80307 can be submitted under NP or PA. Medicare is rejecting charges when submitted under nurse practitioner.

  17. Heather Politz Says:

    I’m having the exact same issue with UHC denying all of our 80307 claims since 01/01/2017. I’ve been transferred around multiple times on multiple occasions only to get absolutely no where. Denial reason I’ve been given by customer service has been “A more appropriate code should be used or to append a modifier to CPT code.” I can’t seem to make them understand that this code was added on 01/01/2017 and replaced G0479 so there really isn’t a more appropriate code. I’ve submitted a reconsideration with medical records and included literature from CMS showing it’s a valid code as well, only to have it denied a second time and denial was upheld for the initial denial reason. I’m stuck and really don’t know where to go from here. I’ve come across a ton of literature for UHC that all contradict themselves. Does anyone have any input on how to get these claims paid??????

  18. Lady Says:

    Has anyone found an answer to the UHC denial of the code 80307? I have spoken to many representatives an they each give a the same that it is not covered under the patients benefits plan.

  19. Zahid Latif Says:

    Any update for 80307 for UHC….

  20. Gail anderson Says:

    If you do a urine drug screen 80307 and a blood alcohol 80307–can a modifier be used to indicate different sample type(59 or XS). Making life difficult.

  21. Deborah Marsh Says:

    Hi, Gail – You should “Report 80307 once, irrespective of the number of drug class procedures or results on any date of service,” according to CPT® guidelines. Hope that’s helpful!

  22. Kim Says:

    Hi All- I just received a couple EOBs from UHC in which I used code 80305 and they were paid. However, it appears that the D.O.S. they are paying on are after 2/1/17 because D.O.S. in January 2017 were denied as not appropriate. Fingers crossed they continue to pay on code 80305. Maybe you all want to give it a try. Good luck!

  23. Kim Says:

    Hi Again- Clarification- I was actually trying to let you know that perhaps UHC will now start paying on 80307 for D.O.S. beginning 2/1/17. We use Dip Cards inhouse so I use code 80305 that was being denied and is now being paid. Just wanted to clarify.

  24. Zahid Latif Says:

    Thank you Kim i also receive payment for 80307 from UHC. But UHC Community Plan still denied 80307. Have you any update for UHC Community Plan. Thanks

  25. Deborah Marsh Says:

    Thanks for keeping the UHC updates coming! I wanted to add another bit of info to the discussion. MLN Matters MM9977 says that the April MPFS update will mark G0477-G0479 with indicator I, which means not valid for Medicare purposes, retroactive back to Jan. 1. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9977.pdf

  26. Susan Fletcher Says:

    If you perform a urine drug screen with a cpt 80306 and then perform an alcohol with a cpt 80307, how can you bill using both cpt’s?

  27. Deborah Marsh Says:

    Hi, Susan Fletcher – CCI edits show a bundle with 80307 in column 1 and 80306 in column 2. The modifier indicator is 0, so you can’t override the edit.

  28. Carolyn Hellersperk Says:

    Is anyone else having this same problem with Tricare denying 80307 as an invalid code?

  29. Sue Hillard Says:

    Does anyone know if we can use 80305 and 80307 together?

  30. Deborah Marsh Says:

    Hi, Sue Hillard – CCI edits show a bundle with 80307 in column 1 and 80305 in column 2. The modifier indicator is 0, so you can’t override the edit.

  31. Sue Hillard Says:

    Deborah Marsh, thank you so much!

  32. MELINDA MULLALLY Says:

    Hi All,
    Can we bill 80307 and G0481 at the same time.
    80307 use to identify possible use or non-use of drug by instrument analyzer right? Then lab result show one or more “Positive”(qualitative or quantitative) result from 8-14 drug classes we use G0481 right? Please help to make sure we can bill both CPT on the same date of service.
    Thank you.

  33. Deborah Marsh Says:

    Hi Melinda Mullally – CPT guidelines state, “A presumptive test may be followed by a definitive test in order to specifically identify drugs or metabolites.” And there is no CCI edit preventing reporting of 80307 and G0481.

    Your payer may have specific medical necessity rules. Check out this Palmetto link that says, “Reflex testing for IA presumptive positives may only be performed by laboratories other than physician office labs (POL). Physicians in POL are expected to determine the medical necessity for definitive testing for a presumptive positive result and document the necessity in the medical record because they have specific patient information and may not need definitive testing.” http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/A59PK51218?OpenDocument

    Hope that helps!

  34. MELINDA MULLALLY Says:

    Thank you Deborah. I hope all insurances doesn’t give us hard time and keep up with all the update code.

  35. jen davis Says:

    Is anyone still having trouble getting 80307 paid by United Healthcare for 01/01/17-01/31/17? We have received payment from 02/1 to current. It seems as though their policy is effective 02/01 only.

  36. Brooke Says:

    Is anyone else having issues with Tricare paying for 80307 for 2017 dates? We are getting denials saying missing/incomplete/invalid codes or amounts?

  37. Carolyn Hellersperk Says:

    Brook, I still cannot get any Tricare pmt for 80307 and they are telling me to refer to policy manual Chapter 6 4.1. ( which to me doesn’t appear to be correctly updated). I don’t know what step to take next.

  38. Shirley Says:

    I have the same problem with UHCC and 80307. One representative told me they didn’t update their files until 2/13/17 to recognize the 8 codes….My claim denied twice again.. Then today another rep told me to add a modifier. I think we need to contact our provider reps to get UHC to get things right and pay our claims. For now, I am going to add QW modifier to 80307 and see what happens.

  39. Shirley Says:

    Just spoke with Rose at UHC Choice who states they updated their files onn4/1 and she was sending my claim back for processing. Maybe you all can resubmit yours or call UHC.

  40. Shirley Says:

    Tricare South has been denying my 80305 but on 4/17 I spoke with a rep at Tricare who stated they just updated their files and would send my claims back for reprocessing..hoping she knows what she is talking about.

  41. Kim Says:

    Hello,
    We are getting denials from Palmetto using code 80305 for UDS is anyone else
    experiencing this? has anyone gotten paid for this? did you bill with Mod.”QW” when billing?
    Thank you

  42. AMY MORRIS Says:

    Brooke,

    Some of the Tricare payers added the 80307 code to their payable list but now I am receiving denials as the code is bundeling with the G0480 (definitive). They are aware of the problem but I was told they are backlogged with over 70K claims to reprocess.

    On another note, Is there any light at the tunnel for Medicare UHC updating their 80307 across the board. It seems some states are paying but some are still denying for medical records.

  43. Diana Says:

    I just received denials from Harvard Pilgrim stating “Procedure modifier was invalid on the date of service. These are billed for dates 4/5, 4/12, 4/21. I billed 80305 QW. Has anyone gotten denials. UHC is completely useless and my boss isnt hearing the excuse that its the insurance company anymore and Im kind of panicking!

  44. Brooke Says:

    Thanks everybody with the help on Tricare relating to the 80307. I have sent some claims back and have received payment on a few since April so hopefully that issue is fixed. However, I am now getting denials from Aetna for the 80307 advising the CO-222 adjustment (exceeds the contracted maximum number of hours/days/units by this provider for this period). Per a rep with Aetna we can’t bill the 80307 along with a G0482 but to my understanding we can and Medicare pays for both codes as well. Does anyone else have this issue happening or have a possible solution? Thanks in advance for any help!

  45. Penny Faricloth Says:

    Can you bill 81001 with 80305 and if so what modifier would you use?

  46. Joan Says:

    Aetna is not paying 80307 along with G0480-G0483 to my knowledge. Any information on this? Thanks.

  47. ushan Says:

    Hi All,

    has anyone been paid for 80307 from Aetna ? we are getting denials stating non covered charges. ? if anyone gets paid, let us know how should we bill this UDS for Aetna ? Really appreciate your help

  48. Tiffany Says:

    Is anyone having issues with BCBS with code 80305 (with and without QW modifier)? Also 80306? I’ve talked to everyone BCBS who said it was an issue with out CLIA certificate. CLIA who said it’s an issue with the FDA who actually waives the devices and codes. BCBS just won’t pay either of these codes. Our practice is has CLIA waived certification so I’m just not understanding at least why the won’t pay 80305? I submitted it before 4/1/17 w/out the QW modifier to get the denial then resubmitted corrected claim after that date with modifier and I’m still getting denied. I’m seriously losing my patience with them and of course the provider customer service is NO help!

  49. Rita Says:

    We have yet to see any resolution for UHC Community Health on 80307 (i.e. no payment) and Medical Mutual for 80307. These drug screens are REQUIRED BY THE STATE. If anyone has had an ICD 10 code that gets them paid PLEASE SHARE.

  50. Karina Says:

    Hi,

    We just started billing 80307 and we are getting all of our claims denied by Medicare. We sent them with the QW mod since we are CLIA certified but they are still coming back. Any help or tips please.

  51. Tiffany Says:

    Karina
    To my knowledge and from my research 80307 can’t be bill with the QW modifier, it’s not a CLIA waived test. Only one that has been CLIA waived with modifier QW is 80305 effective 4/1/17. We are a CLIA waived clinic and I’m still getting denied with the modifier after 4/1/17. Someone somewhere has screwed up big time with these codes which were waived last year and many years before prior to them being changed for 2017: 80305 (QW), 80306, and 80307.

  52. Karina Says:

    Tiffany
    Thanks for the information about the modifier. We are having a lot of trouble getting payments from Medicare 80307 and Medicaid. They are denying everything we sent. Have you or anyone else had any luck getting payments?

  53. Marie Says:

    So I am guessing that CPT 80300 is replaced by 80305. We are also wanting to do rapid urine continine (nicotine) test. What code would that fall under? And now that the G codes are going away, I am not sure how some of the Work Comp carriers will pay.

    Thank you

  54. Tiffany Says:

    Karina
    Luckily for me we are a Medicare and Medicaid opt-out provider so I don’t have to bill either of them. I have heard from practices around here in NC though that do and they are all having the same issues with not getting paid. My biggest issue right now is BCBSNC, they just won’t pay period. Keep denying 80305QW with invalid provider/provider not eligible and this is the ONE code that has been CLIA waived (we do have CLIA waived status). I’m considering filing a claim against with the NC Insurance commission, since they aren’t a government funded insurance company. I just don’t know what else to do. Talking to their provider service reps is doing no good and neither is submitted corrected claims after 4/1/17 as we were told to do. They are still denying claims dated after 4/1/17 with 80305QW. I’ve gone as far as contacting the NC director of CLIA (no help), who told me to go through the FDA who actually deems what tests and tests codes are waived. I’ve contacted the FDA department responsible for this and still haven’t gotten a response. I am completely at a loss when it comes to what they’ve done in 2017 with 80305-80307. These CPT codes drug tests have always been CLIA waived since I’ve been billing them for at least 4 years now, even when they changed the codes like they did again this year. If anyone has any advise or ideas on what to do I am ALL ears!!!

  55. Tiffany Says:

    Marie
    I’m pretty sure 80300 was replaced this year with 80305 modifier QW but you have to be careful about what rapid test you use. Some of them are not CLIA waived tests themselves, so make sure the one you are using or are going to use is a CLIA waived test instrument.

  56. Denise Says:

    When billing presumptive drug screen and/or drug confirmation codes, are you allowed to roll the charges up into one unit in order to bill? CPT 80320, 80349, 80353 where billed, the payer, Cigna, required HCPCS code, G0480. From my understanding, G0480 should only get billed once per day for the patient, even if billed by a different provider. Each cpt code was billed with different charge amounts, so the cpt code was corrected to G0480. Just say these codes were billed at $150 each. Is it correct then to add all the charges up for a grand total of $450 and bill it as 1 unit? These are 2016 claims that I have to correct. Same thing is happening with the presumptive drug screens, they are billing each drug that was tested, then once the claim denied they are adding all codes up into 1 unit and billing G0479. Thanks

  57. Tiffany Says:

    Update on 80305QW in regards to BCBS. I finally got an answer from BCBSNC about them denying this code for the corrected claims sent for services prior to 4/1/17 and new claims after 4/1/17. Per provider services at BCBSNC this code is being denied in error by their system, it is a known issue and they are in the process of getting this corrected to process this code as it should be done with the modifier. Nothing needs to be done of the part of the provider, these claims will be automatically be reprocessed and adjusted for 80305QW by their system once this error is fully corrected. This may be what’s happening with other insurance companies?

  58. Sylvia Says:

    I would appreciate anyone’s thoughts or opinion on this matter….

    I am getting all sorts of denials from BCBSTX in regards to 80305. We have been billing this code since it became effective and now suddenly they are stating this is not payable to our provider(they were paying before). We are a out of network and our Facility performs these tests periodically. When we bill 80305 BCBSTX always request Lab order: Test A, full LC/MS panel and test results signed by MD, which is sent in. Then they come back and deny service for “labs were performed/rendered by another provider” which incorrect and or Facility is not eligible to bill for these services. Another denial is “service is ineligible because medical policy criteria not met for this drug testing/high complexity type of presumptive drugs testing….along with other of BCBSTX verbiage. Which I have read medical criteria and yet to find. I have even talked to a Provider Rep in Escalation Dept and still no help.

    If anyone out there is having similar issues and know of a way to get passed this, kindly reach out to me. I’m in the process of making this a “High Priority Project” but would like to find a much simpler way.

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