Controlled Substances and Drugs of Abuse Testing
This Comparative Billing Report (CBR) focuses on physicians who submit claims for Controlled Substances and Drugs of Abuse Presumptive test Services for CPT® codes 80305-80307, as well as Definitive drug testing services for HCPCS codes G0480-G0483, and G0659. CBR information is one of the many tools used to assist individual providers to become proactive in addressing potential billing issues and performing internal audits to ensure compliance with Medicare coverage guidelines.
For your personalized Controlled Substances and Drugs of Abuse Lab Screening Services codes eCBR results log on to eServices.
Controlled Substances and Drugs of Abuse Lab Screening Services (CPT® codes 80305-80307 and HCPCS codes G0480-G0483, G0659):
Coverage and Documentation Requirements
|CPT® Code||Type of Test||Required Key Components|
|Presumptive||Presumptive and/or definitive drug testing methods are used to detect controlled substances and illicit drugs. Presumptive testing is intended to provide the clinician with rapid test results while the patient is in the office/clinic prior to prescribing a controlled substance. Because presumptive testing can result in false positives or negatives, definitive testing provides confirmatory results for positive and negative tests, respectively.|
|Definitive||Definitive drug testing provides positive identification and frequently quantitation of controlled substances/illicit and/or their metabolites. Medicare recognizes five (5) definitive drug testing codes based on the number of drug classes tested, not the cumulative number of drugs/metabolites tested.|
It is important to note that a definitive drug test may be performed when a presumptive test is negative for a patient on a prescribed medication.
- Only one presumptive service may be billed per patient, per DOS, regardless of the provider. Medicare will process the first presumptive service received per patient, per DOS. All subsequent claims for a presumptive service for the same patient and same DOS will be denied.
- Only one definitive service may be billed per patient, per DOS, regardless of the provider. Medicare will process the first definitive service received per patient, per DOS. All subsequent claims for a definitive service for the same patient and same DOS will be denied.
Remember that the DOS refers to the date of the sample collection, not the date the test was run. To receive reimbursement for controlled substance and drugs of abuse testing, the service reported on the claim must match the service ordered by the physician.
The Provider Outreach and Education (POE) team has published an article to address the issues pertinent to this CBR. Your practice is being advised to review the article entitled
Controlled Substance and Drugs of Abuse Lab Screenings (CPT® 80305-80307 and HCPCS codes G0480-G0483, G0659).
The metrics reviewed in this CBR describe your utilization patterns for Presumptive and Definitive tests with comparisons done to peers with the same specialty in the state and the jurisdiction (North Carolina, South Carolina, Virginia, and West Virginia). This report is an analysis of Medicare Part B claims extracted from the Palmetto GBA data warehouse. For the purpose of this CBR, "peer group" is defined as other providers in Jurisdiction M (JM) who have the same specialty. The analysis shows the portions of your Controlled Substances and Drugs of Abuse Testing Services (CPT® codes 80305-80307 and HCPCS codes G0480-G0483, G0659) claims at each level compared to your peers in JM. Please note that the relevant HCPCS codes for the Controlled Substances Monitoring and Drugs of Abuse Screening family were updated in January of 2017. The codes included in this analysis were those effective during the specified dates of service and may include G0477-G0479 for presumptive testing in addition to those stated above.
Example of eCBR Results from eServices
Please be aware that the information contained within this CBR is not intended to be punitive or an indication of fraud. Rather, it is intended to be proactive communication that will assist you in identifying potential billing issues and help you with performing a self-audit of your conformity with Medicare guidelines.