Saturday, August 14, 2010

IS cpt code 81001 valid - replacement code G0431

CPT G0431 replaces CPT 80101 for Drug Screen Testing 

 

Change Request 6852 addresses CPT G0431 "Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class" as a direct replacement of CPT 80101. 


The following conditions become effective on April 1, 2010:
  • Providers must use CPT G0431 when billing for these services
  • CPT 80101 will no longer be covered by Medicare for dates of service January 1, 2010 and after
For complete information, refer to the CMS Medicare Leaning Network (MLN) article MM6852 "Clinical Laboratory Fee Schedule (CLFS) - Special Instructions for Specific Test Codes (CPT Code 80100, CPT Code 80101, CPT Code 80101QW, G0430, G0430QW, and G0431QW)."
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download