BILLING NEWS

Additional Information Regarding the Calendar Year (CY) 2010 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

This article describes how clinical diagnostic laboratories should bill for certain types of tests that are covered under Medicare and paid based on the Clinical Laboratory Fee Schedule. Specifically, the article addresses billing of four codes (G0430, G0431, 80100, and 80101) during the period of January 1, 2010 through March 31, 2010. Further information will be provided regarding billing after March 31, 2010. It came to CMS’ attention that some companies were using questionable billing practices concerning CPT Code 80100 and CPT Code 80101. In addition, CPT Code 80100 describes only chromatographic testing for the presence of drugs, which left certain laboratories unable to bill accurately when this type of testing was performed, but the chromatographic method was not utilized. Therefore, CMS created two new G codes to operate in place of and alongside existing CPT Code 80100 and existing CPT Code 80101. From January 1, 2010, through March 31, 2010, when performing a qualitative drug screening test for multiple drug classes using chromatographic methods, CPT Code 80100 is the appropriate code to bill. New test code G0430 was created to limit the billing to one time per procedure and to remove the limitation of the method (chromatographic) when this method is not being used in the performance of the test. As a result, when performing a qualitative drug screening test for multiple drug classes that does not use chromatographic methods, new test code G0430 is the appropriate code to bill. New test code G0431 is a direct replacement for CPT Code 80101. However, CMS is delaying this replacement until April 1, 2010. Similarly, from January 1, 2010 through March 31, 2010, when performing a qualitative drug screening test for a single class of drugs, regardless of the testing methodology, those clinical laboratories that do not require a CLIA certificate of waiver should bill new test code G0431. Those clinical laboratories that do require a CLIA certificate of waiver should continue to utilize CPT Code 80101QW. Further direction on this matter will be provided by April 1, 2010.

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INDUSTRY NEWS TAGS: CMS


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