Medicaid Program Integrity: Correct Billing for Drug Screening with Multiplex Drug Test Kit

During recent audits, the Medicaid Program Integrity Unit has identified the incorrect use of CPT code 80101 when billing for drug screening performed with the use of a multiplex drug test kit. Prior to 2011, qualitative testing of multiple drug classes in a single kit was commonly billed using multiple units of CPT code 80101. Code 80104 was created in the 2011 CPT specifically to more accurately reflect the resources used in a multiplex test kit, as compared to multiple runs using a single class methodology. The AMA clarifies, “Code 80104 has been established to report a specific drug screen, qualitative analysis by multiplexed method for 2-15 drugs or drug classes (eg, multidrug screening kit).” Medicare does not accept 80101 or 80104, and instead requires G0431 or G0434. Note that the Medicare codes specify “per patient encounter,” rather than per procedure or per analyte. The CPT 2013 edition, defines code 80101 as a drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class, and further instructs that qualitative analysis by multiplexed screening kit for multiple drugs or drug classes use code 80104. CPT code 80101 should only be reported when performing a unique test, usually performed with an instrument that can withstand repeated use, rather than the individual components of a single multiplex testing kit. The Department will recover payments and assess civil monetary penalties from providers who do not bill CPT code 80104 when using multiplex drug test kits for drug screens.

Source: https://www.idmedicaid.com/MedicAide Newsletters/September 2013 MedicAide.pdf