Drug Testing and Screening Code Updates

Date Issued: 1/1/2016

2015 American Medical Association (AMA) Current Procedural Terminology (CPT) Drug Testing Codes (80300 – 80377)
Consistent with the Centers for Medicare & Medicaid Services' (CMS') coverage guidelines, EmblemHealth will not recognize the new 2015 AMA published drug testing CPT codes 80300 through 80377. These CPT codes are not eligible for health insurance plan reimbursement under the Physician Fee Schedule or under the Clinical Laboratory Fee Schedule.

2016 CMS Drug Testing Codes (G0477 – G0483)
For free-standing and hospital-based clinical laboratories only, EmblemHealth will recognize Healthcare Common Procedure Coding System (HCPCS) codes G0477 through G0483 for drug testing services, consistent with CMS coverage guidelines. However, HCPCS codes G0479 through G0483 are not eligible for reimbursement under the Physician Fee Schedule, and EmblemHealth will not reimburse physicians for these services.

Physician Point-of-Care Drug Screening
Presumptive/Qualitative drug screen testing performed in the physician office setting is eligible for reimbursement when reported with Healthcare Common Procedure Coding System Level II codes G0477 and/or G0478. HCPCS codes G0477 and G0478 will be eligible for one (1) unit of reimbursement per date of service.

Effective January 1, 2016, HCPCS codes G0431 and G0434, and HCPCS codes G6030 through G6058 have been deleted and will not be recognized.