Date Issued: 9/30/2014
Consistent with the Centers for Medicare & Medicaid Services guidelines (for reporting point-of-care qualitative drug-screen testing in a physician’s office), Current Procedural Terminology (CPT®) codes 80100, 80101 and 80104 will not be eligible for reimbursement when the services are billed on POS 11).
Accordingly, qualitative drug screen testing is only eligible for reimbursement when reported with Healthcare Common Procedure Coding System Level II codes G0431 and/or G0434. Both codes G0431 and G0434 will be eligible for one (1) unit of reimbursement per date of service.
Within 90 days of official provider notification (letter sent on 10/1/14), EmblemHealth will reimburse one (1) unit of either code per patient encounter when qualitative testing methods are used. This change will only affect place of service 11 (doctor’s office)*.
Therefore:
- G0431 replaces CPT codes 80100 and 80101
- G0434 replaces CPT code 80104
If claims are received with codes 80100, 80101 or 80104, they will be rejected or denied for invalid CPT codes.
