Medical Billing CPT Urine Screen Codes

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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