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.

Product Name	CPT Code	Product Description
Toxic Element Exposure Hair Testing Kit (Test for 31 Heavy Metals & Toxins)	83015	The test is designed to be a screening examination for checking out the levels of 31 different toxins.
Uri-Check 10SG Urinalysis Reagent Strips (100 Test)	81002	The Uri-Check 10SG urinalysis reagent strip can be read visually or automatically on the Uri-Track 120 urine analyzer to enable point-of-care clinical decisions.
STAT-Site M Hgb Test Cards	85018QW	These cards are used for testing hemoglobin levels and are for use with the STAT-Site MHgb Hemoglobin Photometer.
STAT-Site M Hemoglobin Photometer (Instant Portable Hemoglobin Testing Device)	85018QW	Instant hemoglobin analysis with a single drop of blood from the finger.
STAT-Site Hemoglobin Controls (6 x 1.5 mL (3 low and 3 high level)	85018QW	These control fluids are used to test hemoglobin in blood and are to be used with the STAT-Site MHgb Hemoglobin Photometer. Kit includes 3 high level and 3 low-level controls and each vial contains 1.5 mL of liquid.
RELY Mono Rapid Test (20 Test) RELY	86308QW	Stanbio's RELY Rapid Mono Test results allow for immediate detection and start to therapy to ease discomfort and shorten patients' wait time, minimizing the use of unnecessary antibiotics and helping reduce the risk of infecting others.
QuStick Strep A Rapid Strip (Throat Swab) (50 Test)	87880QW	This kit provides early diagnosis of Strep A infection, which means more cost-effective treatment and increased patient satisfaction.
Comprehensive Organix Compound Profile Urine Test (Quantitative Organic Acids Test)	83921	The Organix Comprehensive contains an extensive analyte lists including markers such as Quinolinate, D-Arabinitol, and 8-Hydroxy-2'deoxyguanosine.
Nutrient and Toxic Elements Premium Urine Test	83018	This test kit includes everything you need to obtain, prepare and ship a urine sample to be tested for nutrient and toxic elements in the body.
Amino Acid Premium Testing Kit - Fingerstick Blood Test (20 Analytes)	82139	This test kit includes everything you need to obtain, prepare and ship a blood sample to be tested for 20 essential amino acids in the body.
ThyroTest Bulk - CLIA Waived Thyroid TSH Instant Testing Kit for Detecting Hypothyroidism	84443QW	This TSH blood test provides a qualitative determination of thyroid stimulating hormone (TSH) in whole blood samples at concentrations > 5 ml U/L. The thyroid test is intended for ambulatory adult and cannot be used in screening newborn for hypothyroidism.
Mephedrone and MDPV Bath Salts Urine Test Kit	82542	This Mephedrone and MDPV Bath Salts Urine Test quantifies the presence of Mephedrone and MDPV in the urine. The test will measure both compounds down to concentrations of 1 ng/mL using a high-performance liquid chromatography with tandem mass spectrometry (LC/MS) technique.
Clarity Strep-A Dip Stick Test Kit	87880QW	The Clarity Strep-A Dip Stick Test Kit offers a fast and easy way to detect the presence of Strep A antigen directly from throat swab specimen.
Clarity Pregnancy Urine Test Strips HCG	81025	Pregnancy Urine Test Strips determines HCG (human chorionic gonadotropin) in urine to detect pregnancy. It is easy to use and provides accurate results in 40 seconds.
Clarity Pregnancy Urine Test Strips HCG	81025	Pregnancy Urine Test Strips offer a quick and simple method to determine HCG (human chorionic gonadotropin) in urine for early detection of pregnancy.
Clarity Mononucleosis Rapid Test Cassettes	86308QW	The Mononucleosis Rapid Test is a fast and easy screening device for the qualitative detection of infectious Mononucleosis Heterophile Antibodies in whole blood, serum or plasma.
Synthetic Marijuana Testing (JWH-018, JWH-073, K2, Spice) and traditional Marijuana	85541	The synthetic marijuana urine laboratory test offered on TestCountry is designed to test for the two synthetic cannabinoids most commonly found in herbal incense products, such as JWH-018 and JWH-073.
Salvia Divinorum Urine Laboratory Test Kit	82542	This Salvia Divinorum urine laboratory test kit quantifies the presence of Salvinorin A (the primary active ingredient of Salvia) and Salvinorin B (the main metabolite of Salvinorin A) in the urine. The test will measure both compounds down to concentrations of 2 ng/mL using a high-performance liquid chromatography with tandem mass spectrometry (LC/MS) technique.
K2 / Spice Synthetic Marijuana JWH018 Saliva Laboratory Drug Testing Kit	85541	This K2/Spice Synthetic Marijuana JWH018 Saliva Laboratory Drug Test is used to test for JWH-018. This synthetic marijuana saliva test requires 0.5 ng/mL of saliva sample which may be collected randomly or on the spot.
Morphine/Opiates CLIA Waived Urine Drug Test Kit Dip Cassette	G0431QW	This Single Panel Urine drug test kit is CLIA waived.
Testosterone - Saliva Hormone Level Imbalance Testing Service (Includes Saliva Collection Kit)	84402	This testosterone saliva testing service is an efficient way to find out if you're having testosterone imbalance that might be triggering your symptoms.
Progesterone (Pg) - Saliva Hormone Level Imbalance Testing Service (Includes Saliva Collection Kit)	84144	This saliva progesterone imbalance testing service is used to measure the progesterone levels in your body.
Saliva Hormone Level Imbalance Testing Service - Tests for 8 Essential Hormones (Includes Saliva Collection Kit)	82670, 84144, 84402,     82627, 82530 x 4	This multi-panel hormone testing service provides an efficient way to determine your hormone levels. It aims to evaluate eight essential hormones, such as Estradiol, Progesterone, Testosterone, DHEA-S and morning Cortisol, as well as noon, evening and night Cortisol.
Hormone Level Imbalance Testing Service - Tests for 6 Essential Hormones (Includes Saliva Collection Kit)	82670, 84144, 84402, 82627,82530 x 2	This multi-panel hormone level imbalance testing service can help you ascertain whether or not your symptoms are associated with the abnormal levels of some of the most important hormones in your body.
Saliva Hormone Level Imbalance Testing Service - Tests for 5 Essential Hormones (Includes Saliva Collection Kit)	82670, 84144, 84402, 82627, 82530	This saliva hormone imbalance testing service aims to evaluate 5 essential hormones in your body, such as Estradiol, Progesterone, Testosterone, DHEA-S, and morning Cortisol.
Estrone (E1) - Saliva Hormone Level Imbalance Testing Service (Includes Saliva Collection Kit)	82679	This saliva Estrone testing service can tell you if your Estrone levels are within the expected optimal range
Estriol (E3) - Saliva Hormone Level Imbalance Testing Service (Includes Saliva Collection Kit)	82677	This saliva estriol hormone imbalance testing service is particularly useful during pregnancy to know if your estriol levels are within the expected optimal range. Existing literature mentions that low levels of "unconjugated estriol" in pregnant women may indicate fetal chromosomal issues.
Estradiol (E2) - Saliva Hormone Level Imbalance Testing Service (Includes Saliva Collection Kit)	82670	This saliva Estradiol imbalance testing service can tell you if your Estradiol levels are within the expected optimal range depending on your age and sex.
DHEA-S - Saliva Hormone Level Imbalance Testing Service (Includes Saliva Collection Kit)	82627	This DHEA-S hormone imbalance testing service can be useful in understanding the causes of your symptoms.
AM Cortisol (C) - Saliva Hormone Level Imbalance Testing Service (Includes Saliva Collection Kit)	82530	This method of testing involves the collection of your saliva and is a very easy, convenient and accurate means of determining your AM Cortisol levels.
ThyroChek - Premium Instant TSH (Thyroid) Screening Test	84443QW	The thyroid test is intended for ambulatory adult and cannot be used in screening newborns for hypothyroidism.
Sleep Strip - Sleep Apnea Syndrome (SAS) At Home Screen Test Kit	95806	A low-cost screening device, which may help screen the general population and locate potential patients, and at the same time help minimize unnecessary and expensive studies.

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 G0483

This code is the general code that must be billed whenapplying for reimbursement for drugs of abuse testing.

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.