FIRST COAST SERVICE OPTIONS
LOCAL COVERAGE DETERMINATION
CODING GUIDELINES

Contractor’s Determination Number

G0431

LCD Database ID Number

L30574

Contractor Name

First Coast Service Options, Inc.

Contractor Number

09102 – Florida
09202 – Puerto Rico
09302 – Virgin Islands

LCD Title

Qualitative Drug Screening

Coding Guidelines

Effective April 1, 2010, when performing a qualitative drug screening test for multiple drug classes that use chromatographic methods.    CPT code 80100 is the appropriate code to bill.  HCPCS code G0430 was created to limit the billing to one time per procedure and to remove the limitation of the method (chromatographic).  Therefore, when a clinical laboratory that does not require a CLIA certificate of waiver performs a qualitative drug screening test for multiple drug classes that does not use chromatographic methods, HCPCS code G0430 is the appropriate code to bill.   When a clinical laboratory that does require a CLIA certificate of waiver performs a qualitative drug screening test for multiple drug classes that does not use chromatographic methods, HCPCS code G0430QW is the appropriate code to bill.

 

Effective April 1, 2010, HCPCS code G0431 should be utilized by those clinical laboratories that do not require a CLIA certificate of waiver.  Those clinical laboratories that do require a CLIA certificate of waiver should utilize HCPCS code G0431QW.

 

Effective January 1, 2011, HCPCS code G0430 was deleted and replaced with HCPCS code G0434 – Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter.  In addition, CPT code 80100 is no longer a valid code for Medicare purposes and HCPCS code G0431 should be billed when applicable.

 

Effective April 1, 2011, code G0431QW is deleted from the Clinical Laboratory Fee Schedule (CLFS). Code G0431 describes a high complexity test, and should not be reported with a QW modifier; the QW modifier indicates a Clinical Laboratory Improvement Amendments (CLIA) waived test.

 Also,                                                                                                                                                                                               

Effective April 1, 2011, code G0434QW is added to the CLFS. Code G0434 can describe a CLIA waived test. The use of the QW modifier to indicate a CLIA waived test is necessary for accurate claims processing.

 

 

Both HCPCS codes G0431 and G0434 will remain on the CLFS.

Use CPT code 80102 for drug confirmation.

For management of patients under treatment of substance abuse or management of patients with chronic pain, point of service qualitative urine drug screen is the most frequently utilized testing.  This testing is described by G0434 and is billed one unit per patient encounter.

Comments

N/A

Revision History

Date

Revision

04/01/2011

5- Under  the “Coding Guidelines” section, based on JSM/TDL 11259, language was replaced from previous JSM 11194 and CRs 6991 and 7266 showing a different effective date of April 1, 2011 for deletion of HCPCS code G0431QW from the CLFS, and addition of HCPCS code G0434QW to the CLFS.  The effective date of this revision is based on date of service.         

03/03/2011

4- Under the “Coding Guidelines” section, based on JSM 11194 and Change Request 7266 language was added regarding the deletion of HCPCS code G0431QW from the CLFS, and addition of HCPCS code G0434QW to the CLFS. The effective date of this revision is for claims processed on or after 03/03/2011 for dates of service on or after 01/01/2011.

02/13/2011

3- Under the “Coding Guidelines” section, language was added to clarify point of service qualitative urine drug screen for number of units billed. Also, based on CR7300, effective 1/1/2011, CPT code 80100 was noted as no longer being a valid code.  The effective date of this Coding Guidelines revision is based on date of service.

01/01/2011

2 – January 2011 HCPCS information regarding HCPCS code G0430 replaced with HCPCS code G0434 was added under the “Coding Guidelines” section.  The effective date of this revision is based on date of service.

04/01/2010

1 - Deleted previous instructions regarding the billing of qualitative drug screening.  Added information related to procedure codes 80100, G0430 and G0431 and the use of modifier QW.  The effective date of this revision is based on date of service.

01/25/2010

Original

 

Document formatted: 03/30/2011 (DA/et)