Medicare billing CPT 80100 80101, G0430 , G0431

Key Points of CR 6852

Each test code discussed in CR 6852 is currently described as follows by the American Medical Association (AMA) (CPT Codes) and CMS (G Codes):

• CPT Code 80100 – Drug screen, qualitative; multiple drug classes chromatographic method, each procedure

• CPT Code 80101 – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

• CPT Code 80101QW – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

• G0430 – Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure

• G0430QW – Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure

• G0431 – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

• G0431QW – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

For purposes of the Clinical Laboratory Fee Schedule (CLFS), beginning with dates of service on or after April 1, 2010, when performing a qualitative drug screening test for multiple drug classes that uses chromatographic methods, CPT Code 80100 is the appropriate code to bill.

New test code G0430 was created to limit the billing to one time per procedure and to remove the limitation of the method (chromatographic) when this method is not being used in the performance of the test. As a result, when a clinical laboratory that does not require a CLIA certificate of waiver performs a qualitative drug screening test for multiple drug classes that does not use chromatographic methods, new test code G0430 is the appropriate code to bill.

When a clinical laboratory that does require a CLIA certificate of waiver performs a qualitative drug screening test for multiple drug classes that does not use chromatographic methods, new test code G0430QW is the appropriate code to bill.

Remember: New test code G0431 is a direct replacement for CPT Code 80101. For purposes of the CLFS, effective with dates of service on or after April 1, 2010, new test code G0431 should be utilized by those clinical laboratories that do not require a CLIA certificate of waiver. Those clinical laboratories that do require a CLIA certificate of waiver should utilize new test code G0431QW. Effective April 1, 2010, CPT Code 80101 will no longer be covered by Medicare, and CPT Code 80101QW will be deleted.