Medicaid Colorado – Laboratory Services – Recently Published Billing Manuals Updates

Papanicolaou (Pap) Smears

Health First Colorado allows one pap smear screening/examination per 12-month period in women under 40 years of age. Benefit for more than one Pap smear in a 12-month period is allowed for women ages 40 and over, women with a history of diethylstilbestrol exposure in utero, women with malignancy of the cervix, vagina, uterus, fallopian tubes or ovaries, women with cervical polyps, cervicitis, neoplastic disease of the pelvic organs, vaginal discharge or bleeding of unknown origin, postmenopausal bleeding, or vaginitis, or if the physician determines that more frequent testing is needed and is medically necessary. Claims will deny if the diagnosis code entered on the claim does not support the testing frequency.

Drug Testing Unit Limitations and Documentation Requirements

Current Procedural Terminology (CPT) codes 80305, 80306 and 80307 have a unit limit of four (4) per month per client for each code. This unit limit applies to all provider types.

As of January 2020, substance-specific confirmatory tests no longer require a positive or inconclusive presumptive test or medical necessity documentation attached to the claim to be considered for reimbursement.

As of August 1, 2021, HCPCS G0480-G0483 should be used when billing for substance-specific confirmatory tests. CPT codes 80320-80377 were closed as of July 31, 2021.

 

Source: https://hcpf.colorado.gov/laboratory-billing#labServ