Question:

What codes are reported for urine drug definitive testing, and how many UOS should be reported?

Answer:

Beginning January 1, 2016, urine drug definitive testing may be reported with HCPCS codes G0480–G0483 and may be reported “per day.” They should not be reported with more than one UOS per day. However, effective January 1, 2017, CMS implemented the following urine drug definitive testing code, which is reported “per day” but not more than one UOS per day.

G0659

Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem), excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes

Medicare requires the use of HCPCS G codes for definitive drug testing since CPT codes 80320-80377 and 83992 are assigned a status indicator B under the OPPS. Many of the drug class CPT code descriptors indicate a number of drug analytes and metabolites that may be tested. The applicable definitive code will be selected based on the number of drug analytes and/or metabolites chosen to be analyzed in the class. Only one unit may be reported for each CPT definitive drug class test. For example, 10 benzodiazepines and/or metabolites were analyzed. Code 80346 will be selected and reported with one unit.

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