937-477-6808
Commercial/Medicaid
Drug Screening Codes and Descriptions
80101 Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay) each drug class. Use this code when billing for high complexity analyzer tests in a provider’s office setting or independent lab. Confirmatory quantitative testing is required for positive test results. Clinical consideration and professional judgment should be applied to any drug test result. Refer to your laboratory consultant to confirm that your test equipment is operating and qualifies as high complexity. Refer to your commercial/Medicaid state guidelines.
80104 Multiple drug class other than chromatographic method, each procedure. A number of different methods are available to screen for qualitative, non-chromatographic, multiple drug class essays, including multiplex screening kits, urine cups, test cards, and test strips. This code is a new code as of 2011. Adding the QW modifier indicates a CLIA waived test. Use this code when billing for multiplex screening kits, urine cups, test cards, test strips, etc. Check with your vendor for product information. Refer to your commercial/Medicaid state guidelines.
81002 Urinalysis
by dipstick PH, specific gravity non-automated, without microscopy. This test is used to perform a specimen
validity test to indicate if a urine specimen has been diluted, substituted, or
adulterated in any fashion by use of a dipstick. Check with your vendor for product information. Refer
to your commercial/Medicaid state guidelines.
82055 Alcohol:
enzymatic rate analysis (alcohol dehydrogenase) any specimen except breath.
This
test is used to detect alcohol. Add a QW
modifier to 82055 to indicate a CLIA waived test. Check with your vendor for product
information. Refer to your commercial/Medicaid state guidelines.
82570 Creatinine
other source (urine). Check with your vendor for product information. Refer
to your commercial/Medicaid state guidelines.
99000 Handling
and/or conveyance of specimen for transfer from the physician’s office to a
laboratory. Use this code when the
doctor’s employed staff documents the results of a urine screen, labels, and
packages the specimen for shipping. Providers
may bill for this code only when their employed staff documents the results of
a urine screen, labels, and packages the specimen. Refer to your
commercial/Medicaid state guidelines.
Modifier 91 Repeat Clinical Diagnostic Laboratory Test. Some carriers require this modifier to pay for
more than one unit. Refer to your commercial/Medicaid
state guidelines.
Medicare/Medicaid/Aetna
Drug Screening Codes and Descriptions
G0434 Drug screen, other than
chromatographic; any number of drug classes, by CLIA waived test or moderate
complexity test per patient encounter. This
code was introduced in 2011 replacing the G0430. G0434 is used to report very simple testing
methods such as cups. Adding the QW
modifier indicates a CLIA waived test.
Only one unit of service can be billed per patient encounter regardless
of the number of drug classes tested and irrespective of the use or presence of
the QW modifier on claim lines. Some Medicaid
state guidelines require this code. Refer to your Medicare/Medicaid state
guidelines.
G0431 Drug screen, qualitative; multiple
drug classes by high complexity test method (e.g., immunoassay, enzyme assay),
per patient encounter. The description
of this code was changed in 2011 to report more complex testing; such as
multi-channel chemistry analyzers. This
code is used if instrumented systems (i.e., durable systems capable of
withstanding repeated use) are being used and the drug screen tests are
classified as CLIA high complexity tests. G0431 should not be reported with a QW modifier
and only one unit of service can be billed per patient encounter, regardless of
the number of drug classes tested. Some
Medicaid state guidelines require this code.
Refer to your laboratory
consultant to confirm that your instrumented systems are operating at CLIA high
complexity test levels and. Refer to
your Medicare/Medicaid state guidelines.
Medicare/Medicaid Drug Screening Codes and Descriptions
81002 Urinalysis
by dipstick PH, specific gravity non-automated, without microscopy. This test is used to perform a specimen
validity test to indicate if a urine specimen has been diluted, substituted, or
adulterated in any fashion by use of a dipstick. Check with your vendor for product
information. Refer to your Medicare/Medicaid
state guidelines.
82055 Alcohol:
enzymatic rate analysis (alcohol dehydrogenase) any specimen except breath.
This
test has is used to detect alcohol. Add
a QW modifier to 82055 to indicate a CLIA waived test. Check with your vendor for product
information. Refer to your Medicare/Medicaid state guidelines.
82057 Creatinine
other source (urine). Check with your vendor for product information. Refer
to your Medicare/Medicaid state guidelines.
Disclaimer:
This document was prepared as a service to the public and is
not intended to grant rights or impose obligations. This article may contain
references or links to statutes, regulations, or other policy materials. The
information provided is only intended to be a general summary. It is not
intended to take the place of either the written law or regulations. We
encourage readers to review the specific statutes, regulations and other
interpretive materials for a full and accurate statement of their contents. 05/01/12
