CPT Codes For Drug Testing

CPT Codes, short for Current Procedural Terminology Codes, are the standard codes used by US medical professionals such as physicians and healthcare providers in reporting and documenting medical, surgical, anesthesiology, laboratory, radiology, evaluation and management services.

About 7,000 five-character CPT codes are being used, and are an essential part of the billing process. These codes are used by insurers to aid in determining the amount of reimbursement that the physician or healthcare provider will receive for the services rendered to a particular individual.

CPT Codes fall under any of three major categories:

Category I

This category is concerned with procedures and contemporary medical practices performed across the United States. This category is generally identified with the 5-character CPT Codes that identify a service or procedure sanctioned by the FDA, and performed by a physician or healthcare professional.

This category is broken down into six sections:

• Evaluation and Management (99201-99499): This includes hospital observation services, office and other outpatient services, consultations, hospital inpatient services, emergency department, critical care services, nursing facility services, and custodial care services.
• Anesthesiology (00100–01999; 99100–99150): This includes procedures of the head, neck, thorax, intrathoracic, spine and spinal column, upper and lower abdomen, and obstetrics.
• Surgery (10000–69990): This includes general surgery, integumentary system, musculoskeletal system, respiratory system, cardiovascular system, digestive system, urinary system, eye and reproductive, to name a few.
• Radiology (70000-79999): This includes ultrasound, mammography, bone/joint, oncology and nuclear medicine.
• Pathology and Laboratory (80000–89398): This includes organ or disease-oriented panels, drug testing, therapeutic drug assays, evocative/suppression testing, consultations (clinical pathology), urinalysis, transfusion medicine, and microbiology.
• Medicine (90281–99099; 99151–99199; 99500–99607): This includes vaccines, toxoids, psychiatry, biofeedback, dialysis, gastroenterology, ophthalmology, special otorhinolaryngologic services, cardiovascular, noninvasive vascular diagnostic studies, pulmonary, allergy and clinical immunology, and endocrinology.

Category II

This pertains to clinical laboratory services. CPT codes for this category consist of secondary tracking codes employed for collecting information regarding the quality of care rendered, and performance measurement. The use of these codes is not mandatory.

Breakdown of Category II CPT Codes are:

• Composite Measures (0001F-0015F)
• Patient Management (0500F-0575F)
• Patient History (1000F-1220F)
• Physical Examination (2000F-2050F)
• Diagnostic/Screening Processes or Results (3006F-3573F)
• Therapeutic, Preventive or Other Interventions (4000F-4306F)
• Follow-up or Other Outcomes (5005F-5100F)
• Patient Safety (6005F-6045F)
• Structural Measures (7010F-7025F)

Category III

These provisional codes are for new and emerging technology, used for the collection of data and assessment of new procedures and services.

There has been confusion among Medicare payers and laboratories with regards to the proper billing of drug tests. With the release of the new HCSPC “G” codes, some other tests that healthcare payers have taken were told to be not covered under these codes.

Frequently Asked Questions on CPT Codes

What is the difference between CPT Codes and HCSPC Codes?

CPT (Current Procedural Terminology) is administered by the American Medical Association (AMA). Meanwhile, Healthcare Common Procedural Coding System (HCPCS) is a standardized coding system for the description of specific services and items.

How can you look up a CPT code for free?

You won’t find a comprehensive list of CPT codes available for free, as the AMA is diligent about maintaining its copyright on them, but in an effort to make CPT codes more accessible to the general public, the AMA does have a tool on its website to look up individual codes.

When and how was HCPCS established?

HCPCS was established in 1978 which was based on AMA’s CPT processes. With the implementation of HIPAA in 1996, facilities started using HCPCS for transaction codes.

What are the HCSPC Levels?

Although HCPCS has its own guidelines, it works hand in hand with CPT codes. The different levels are as follows:

• Level I codes consist of the AMA’s CPT codes and are numeric.
• Level II codes indicate the HCPCS alphanumeric code set, and primarily include non-physician products, procedures, and supplies outside the scope of CPT.
• Level III codes, also called HCPCS local codes, were developed by state Medicaid agencies, Medicare contractors, and private insurance companies for the purpose of specific programs and scope. These items may be found in the HCPCS reference coding book. Some coders are required to indicate Level III codes and opt the code sets for Levels I and II, but these codes are not accepted in all states.

What are the non-physician services covered under HCSPS Codes?

HCPCS Level II codes are used for billing and identifying items and services such as:

• Ambulance services
• Drugs, infusion additives, and ancillary surgical supplies
• Non-physician services not covered by CPT codes (Level I codes)
• Prosthetic devices

How would you determine which could to use along with your health plans?

Different health insurance companies may use different kinds of codes. It is best to know which codes your health insurance company uses by knowing the following:

• When the CPT and a HCPCS Level II code for a specific service or procedure have pretty much the same narratives, using the CPT code is recommended. Otherwise, the HCPCS Level II code should be used instead.
• Check for a HCPCS national code when a CPT code description contains an instruction to include additional information, such as describing a specific medication.

What are the products at TestCountry.com with CPT Codes?

Below are the TestCountry.com products with CPT Codes.

What are the newly released “G” Codes?

The following codes are the newly released “G” codes that the Centers for Medicare and Medicaid Services (CMS) currently recognize:

HCPCS CODE G0477

A presumptive drug test used in any number of drug classes, any number of devices or procedures capable of being read by direct optical observation only (such as dipsticks, cups, cards, and cartridges) that includes sample validation when performed per date of service.

HCPCS CODE G0478

A presumptive drug test used in any number of drug classes, any number of devices or procedures read by instrument-assisted direct optical observation such as dipsticks, cups, card and cartridges that includes sample validation when performed per date of service.

HCPCS CODE G0479

A presumptive drug test used in any number of drug classes, any number of devices or procedures by instrumented chemistry analyzers (utilizing immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, DHPC, and GC mass spectrometry) that include sample validation when performed per date of service.

HCPCS CODE G0480

A drug test definitive that uses any of the following:

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)
• LC/MS: any type, single or tandem and excluding immunoassays (IA, EIA, ELISA, EMIT, FPIA)
• Enzymatic methods: such as alcohol dehydrogenase.
• Stable isotope or other universally recognized internal standards in all samples, such as to control for matrix effects, interferences and variations in signal strength.
• Method or drug-specific calibration and matrix-matched quality control material, such as to control for instrument variations and mass spectral drift; qualitative or quantitative, all sources, includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed.

HCPCS CODE G0481

A drug test definitive that uses any of the following:

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)
• LC/MS: any type, single or tandem and excluding immunoassays (IA, EIA, ELISA, EMIT, FPIA)
• Enzymatic methods: such as alcohol dehydrogenase.
• Stable isotope or other universally recognized internal standards in all samples, such as to control for matrix effects, interferences and variations in signal strength.
• Method or drug-specific calibration and matrix-matched quality control material, such as to control for instrument variations and mass spectral drift, qualitative or quantitative, all sources, includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed.

HCPCS CODE G0482

A drug test definitive that uses any of the following:

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)
• LC/MS: any type, single or tandem and excluding immunoassays (IA, EIA, ELISA, EMIT, FPIA)
• Enzymatic methods: such as alcohol dehydrogenase.
• Stable isotope or other universally recognized internal standards in all samples, such as to control for matrix effects, interferences and variations in signal strength.
• Method or drug-specific calibration and matrix-matched quality control material, such as to control for instrument variations and mass spectral drift, qualitative or quantitative, all sources, includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed.

HCPCS CODE G0483

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)
• LC/MS: any type, single or tandem and excluding immunoassays (IA, EIA, ELISA, EMIT, FPIA)
• Enzymatic methods: such as alcohol dehydrogenase.
• Stable isotope or other universally recognized internal standards in all samples, such as to control for matrix effects, interferences and variations in signal strength.
• Method or drug-specific calibration and matrix-matched quality control material, such as to control for instrument variations and mass spectral drift, qualitative or quantitative, all sources, includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed.

What are the limitations of these drug tests?

Only one presumptive/definitive test may be billed to a patient per DOS. This means that subsequent tests will be denied.

What problems did Medicare payers and laboratories experience after the release of the “G” codes?

The release of the “G” codes created confusion in properly coding for the right test as well as proper billing of the tests provided.

What could be the effect of not being aware of using the right codes for billing?

It will have a negative impact on the revenues of the laboratories as well as the insurance payers paying incorrectly or insurance companies denying them for incorrect reasons.

Therefore, it is essential to be updated with the latest codes being used to ensure that the right codes match the kind of service or procedure performed on a patient/person.