HCPCS Code G0431 – Updates
Effective January 1, 2011, CMS will utilize two test codes to report drug screen testing:
- HCPCS code G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter) will be used to report very simple testing methods, such as dipsticks, cups, cassettes, and cards, that are interpreted visually, with the assistance of a scanner, or are read utilizing a moderately complex reader device outside the instrumented laboratory setting (i.e., non-instrumented devices). This code is also used to report any other type of drug screen testing using test(s) that are classified as Clinical Laboratory Improvement Amendments (CLIA) moderate complexity test(s), keeping the following points in mind:
- HCPCS code G0434 includes qualitative drug screen tests that are waived under CLIA as well as dipsticks, cups, cards, cassettes, etc, that are not CLIA waived.
- Laboratories with a CLIA certificate of waiver may perform only those tests cleared by the Food and Drug Administration (FDA) as waived tests. Laboratories with a CLIA certificate of waiver shall bill using the QW modifier.
- Laboratories with a CLIA certificate of compliance or accreditation may perform non-waived tests. Laboratories with a CLIA certificate of compliance or accreditation do not append the QW modifier to claim lines.
- Only one unit of service for HCPCS code G0434 can be billed per patient encounter regardless of the number of drug classes tested and irrespective of the use or presence of the QW HCPCS modifier on claim lines.
- HCPCS code G0431 (Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter) will be used to report more complex testing methods, such as multi-channel chemistry analyzers, where a more complex instrumented device is required to perform some or all of the screening tests for the patient. Note that the descriptor has been revised for CY 2011. This code may only be reported if the drug screen test(s) is classified as CLIA high complexity test(s) with the following restrictions:
- HCPCS code G0431 may only be reported when tests are performed using instrumented systems (i.e., durable systems capable of withstanding repeated use).
- CLIA waived tests and comparable non-waived tests may not be reported under test HCPCS code G0431; they must be reported under test HCPCS code G0434.
- CLIA moderate complexity tests should be reported under test HCPCS code G0434 with one (1) Unit of Service (UOS).
- HCPCS code G0431 may only be reported once per patient encounter.
- Laboratories billing HCPCS code G0431 must not append the QW HCPCS modifier to claim lines.
CMS has also made changes to the following related tests:
- HCPCS code G0430 was deleted as of January 1, 2011;
- CPT code 80100 has not been priced under Medicare effective January 1, 2011; and
- CPT code 80104 has not been priced under Medicare effective January 1, 2011.
Also, please remember that CPT code 80101 has not been priced under Medicare since July 1, 2010.