Forum - Questions & Answers

Jan 10th, 2015 - taradalyn1 16 

80104 Urine Drug Screen

From what I am reading 80104 is no longer a valid code and should be replaced by 80300. 80300 is being rejected at my clearinghouse as not valid either. Is there a different code I should be using?

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Jan 13th, 2015 - LBAROGIANIS 250 

re: 80104 Urine Drug Screen

This is an article that I found:
The Health Plan follows the Centers for Medicare & Medicaid Services (CMS) guidelines for reporting point of care qualitative drug screen testing in a physician’s or other qualified health care professional’s office, independent laboratory, or hospital laboratory. Therefore, Current Procedural
Terminology (CPT®)' codes 80100, 80101, and 80104 are considered bundled services and will not be eligible for reimbursement. (See also our Bundled Services and Supplies reimbursement policy.) Qualitative drug screen testing is only eligible for reimbursement when reported with Healthcare Common Procedure Coding System Level II (HCPCS) codes G0431 (as replacement of CPT® codes 80100 and 80101) and/or G0434 (as replacement of CPT® code 80104)and both codes are eligible for one unit of reimbursement per date of service. Use of code G0431 is limited to high complexity testing therefore, as a condition of reimbursement, the Health Plan may require documentation of
FDA-approved complexity level for instrumented equipment, and/or CLIA Certificate of Registration, Compliance, or Accreditation as a high complexity lab.

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Jan 14th, 2015 - taradalyn1 16 

re: 80104 Urine Drug Screen

Thank you for your help!

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