Sunday, September 26, 2010

Drug cpt coding - 80101

CPT Coding and Drugs of Abuse Testing Recommendations

It is our recommendation based on the currently available information that the appropriate CPT code
for on-site drugs of abuse test kits is;

80101* – Drug Screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay)
*add QW modifier if billing Medicare/Medicaid

For code 80101, each single drug class method tested and reported is to be counted as one drug
class. If a sample is analyzed by five separate class-specific immunoassays and reported separately,
code 80101 should be reported five times. Similarly, if a sample is run on a rapid assay kit composed
of five class-specific immunoassays in a single kit, and the five classes are reported separately, code
80101 should again be reported five times.

X the number of drug classes being tested
2009 National Limit: $20.11


                                Drug Classes for Billing Purposes
Test Calibrator Cut-off
Amphetamine (AMP 1,000) d-Amphetamine  1,000 ng/mL
Barbiturates (BAR)  Secobarbital  300 ng/mL
Benzodiazepines (BZO)  Oxazepam  300 ng/mL
Buprenorphine (BUP)  Buprenorphine  10 ng/mL
Cocaine (COC 300)  Benzoylecgonine  300 ng/mL
Marijuana (THC)  11-nor-Δ9-THC-9 COOH  50 ng/mL
Methadone (MTD)  Methadone  300 ng/mL
Methamphetamine (mAMP 1,000)  Methylenedioxymethamphetamine (MDMA) Ecstasy  d,l Methylenedioxymethamphetamine  500 ng/mL
Opiate (MOP 300)  Morphine  300 ng/mL
Opiate (OPI 2,000)  Morphine  2,000 ng/mL
Oxycodone (OXY)  Oxycodone  100 ng/mL
Phencyclidine (PCP)  Phencyclidine  25 ng/mL
Propoxyphene (PPX)  Propoxyphene  300 ng/mL
Tricyclic Antidepressants (TCA)  Nortriptyline  1,000 ng/mL

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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