Drug Testing Reimbursement Delays Possible for 2014 - DoctorsManagement Drug Testing Reimbursement Delays Possible for 2014 - DoctorsManagement

Drug Testing Reimbursement Delays Possible for 2014

By Kevin Townsend, CMPE, CPC, CPMA | December 16, 2014

The American Medical Association (AMA) created 63 new codes describing a series of tests for the presence of various drugs. The codes include both presumptive tests and definitive tests. They are intended to replace the existing CPT codes and G0430 and G0431 for qualitative drug screening as well as a broad range of established CPT codes for quantitative drug level determination.

In its preliminary decision, CMS reiterated its long-standing concerns about the potential for fraudulent and abusive billing of these drug tests and decided to delay decision-making on pricing for the new codes. CMS is concerned that the structure of the new drug testing codes may not prevent abusive billing. CMS will also continue to evaluate coding and pricing for these tests. 

Codes G0430 and G0431 may continue to be billed at this point for Medicare and any other payers accepting these codes. CMS and most commercial payers have not, however, released pricing for any of the new codes and it is unclear how CMS will handle the discontinuation of some CPT drug testing codes in 2015.

DoctorsManagement is following this situation closely and will continue to update you as more information is available. We will also be distributing an updated white paper that conveys full descriptions of these new codes along with instructions for their use.

As always, please contact us with any questions or concerns via email or call 800-635-4040.