HCPCS Drug Testing limits

In a recent provider notification on December 14, 2015 regarding HCPCS Drug Testing Codes Effective January 1, 2016, Anthem advised that CMS will use new HCPCS “G” codes for “per day” presumptive (G0477-G0479) and definitive (G0480-G0483) drug testing. Beginning with dates of service on or after January 1, 2016, Anthem accept these “G” code and will apply a frequency limit of 1 unit per date of service on HCPCS codes HCPCS codes G0477 – G0483. They will also apply a frequency limit of 18 units per 365 days on HCPCS definitive drug testing codes G0480 –G0483. This edit will use claim lines processed in history with prior, current, and subsequent dates of service to accumulate and apply this frequency limit.