Drug Screening Assays Billing Guidelines

Blue Cross strongly encourages all providers (lab and non-lab) to bill HCPCS code G0431 (drug screen, qualitative; multiple drug classes by high complexity test method [e.g., immunoassay, enzyme assay], per patient encounter) when performing moderate/high complexity machine tests. CPT® code 80101 is limited to one unit. Non-lab providers who perform urine toxicology tests should use the following CPT/HCPCS codes to report non-instrumented drug screen testing methods that include but are not limited to dipsticks, cups, cassettes and cards. These procedures are limited to one unit per date of service:

• 80104  (Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure”)

• G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter)

Routine periodic audits will be performed. Providers discovered to be billing inappropriately will be subject to a more detailed review and possible recoupment of overpayment.