Drug Screening Tests clarified in manual

Section 13 of the Physician Manual has been replaced to provide additional clarity to the policy stated in subsection 13.41.E.  The following paragraph was added:

Qualitative and semi-quantitative drug screening tests are covered by the MO HealthNet Program.  Refer to the CPT book for appropriate procedure codes to reflect testing on single or multiple drug classes.  A drug screen test reports what drug classes (e.g., tricyclic antidepressants, phenothiazines, amphetamines, benzodiazepines, barbiturates, cannabinoids, methadone, opiates) are present (qualitative) and may provide an estimate (semi-quantitative) of the concentration.  An initial drug screen or preliminary test that yields qualitative or semi-quantitative results must be reported with an appropriate drug testing procedure code categorized as such in the CPT book. Codes in the Therapeutic Drug Assay or Chemistry Sections of the CPT book may not be used to report qualitative or semi-quantitative drug screening and preliminary test results.  Physician offices may bill for initial drug screens performed at point of care (e.g., by use of CLIA waived test devices) or independent and/or hospital laboratories may bill for screenings they performed, but both cannot be billed.  It shall be the responsibility of the ordering physician to coordinate with the performing laboratory for the billing of drug screen tests. Providers should not routinely bill for the quantification of drug classes. Providers should only bill for the quantification of a drug class or a confirmatory drug test (i.e., billing procedure codes from the Therapeutic Drug Assay or Chemistry sections of the CPT book) if there is a positive screen for the drug class to be quantified.