Clinical Laboratory Fee Schedule (CLFS) – Special Instructions for Specific Test Codes (CPT Code 80100, CPT Code 80101, CPT Code 80101QW, G0430, G0430QW, and G0431QW)

During calendar year (CY) 2009, effective for January 1, 2010, two new G codes were established: G0430 and G0431. It had come to CMS’ attention that some providers were incorrectly using CPT Code 80100 and CPT Code 80101. Therefore, CMS created two new G codes to operate in place of and alongside existing CPT Code 80100 and existing CPT Code 80101. For purposes of the CLFS, beginning with dates of service on or after April 1, 2010, when performing a qualitative drug screening test for multiple drug classes that uses chromatographic methods, CPT Code 80100 is the appropriate code to bill. New test code G0430 was created to limit the billing to one time per procedure and to remove the limitation of the method (chromatographic) when this method is not being used in the performance of the test. As a result, when a clinical laboratory that does not require a CLIA certificate of waiver performs a qualitative drug screening test for multiple drug classes that does not use chromatographic methods, new test code G0430 is the appropriate code to bill. When a clinical laboratory that does require a CLIA certificate of waiver performs a qualitative drug screening test for multiple drug classes that does not use chromatographic methods, new test code G0430QW is the appropriate code to bill.