New Medicare travel allowance fees for specimen collection have been updated in regard to the Clinical Laboratory Fee Schedule (CLFS). Change Request (CR) 6864 revises the 2010 payment of travel allowances, either on a per mileage basis (P9603) or on a flat rate per trip basis (P9604). The implementation date is set for April 5.

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The Centers for Medicare & Medicaid Services (CMS) provides special instructions for the proper use of CPT® codes 80100, 80101, 80101-QW, and HCPCS Level II codes G0430, G0430-QW, G0431, and G0431-QW as of April 1. The instructions impact both the lab fee schedule and list of waived tests.

Effective Jan. 1, two new G codes were established – G0430 Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure and G0431 Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class – as it had come to CMS’ attention that some companies were using questionable billing practices concerning CPT® codes 80100 and 80101. The G codes are meant to operate in place of and alongside 80100 Drug screen, qualitative; multiple drug classes chromatographic method, each procedure and 80101 Single drug class method (eg, immunoassay, enzyme assay), each drug class.

Clinical laboratories requiring a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver had been utilizing 80101-QW. Effective April 1, however, clinical laboratories requiring a CLIA certificate of waiver should use G0430-QW  and G0431-QW to bill correctly, whether the performed drug screen test is for a single drug class or multiple drug classes. The modifier QW CLIA waived test should be appended to codes used for CLIA waived tests.

For purposes of the Clinical Laboratory Fee Schedule (CLFS), beginning April 1, when performing a qualitative drug screening test for multiple drug classes that use chromatographic methods, 80100 is the appropriate code to bill. New test code G0430 was created to limit the billing to one time per procedure and to remove the method’s (chromatographic) limitation when it’s not used in the performance of the test. As a result, when a clinical laboratory not requiring a CLIA certificate of waiver performs a qualitative drug screening test for multiple drug classes not using chromatographic methods, new test code G0430 is the appropriate code to bill. When a clinical laboratory requiring a CLIA certificate of waiver performs a qualitative drug screening test for multiple drug classes not using chromatographic methods, G0430-QW is the appropriate code to bill. New test code G0431 is a direct replacement for 80101. For purposes of the CLFS, beginning April 1, new test code G0431 should be utilized by those clinical laboratories that do not require a CLIA certificate of waiver. Clinical laboratories requiring a CLIA certificate of waiver should utilize new test code G0431-QW.

Effective April 1, code 80101 will no longer be covered by Medicare, and code 80101-QW will be deleted.

The April 2010 hospital Outpatient Prospective Payment System (OPPS) update, released Feb. 26, adds several HCPCS Level II codes to reflect coverage changes, reiterates billing instructions on several points, and corrects payment rate errors in the January and October 2009 OPPS Pricer.

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The Centers for Medicare & Medicaid Services (CMS) recently issued a Medicare Learning Network (MLN) article to clarify how clinical diagnostic laboratories should bill for certain types of tests covered by Medicare and paid under the Clinical Laboratory Fee Schedule (CLFS).

Specifically, MLN SE1001 addresses how labs should presently bill new 2010 HCPCS Level II codes G0430 and G0431 and existing CPT® codes 80100 and 80101.

The current descriptions for said codes are:

• 80100 Drug screen, qualitative; multiple drug classes chromatographic method, each procedure
• G0430 Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure
• 80101 Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class
• 80101QW Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class – CLIA waived test
• G0431 Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class

From Jan. 1 to March 31, labs should report 80100 for qualitative drug screening tests for multiple drug classes when using chromatographic methods and G0430 when not using chromatographic methods.

HCPCS Level II G0431 is a direct replacement for CPT® code 80101. Although CMS is delaying implementation of G0431 until April 1, the agency instructs labs who do not require a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver to report qualitative drug screening tests for a single class of drugs, regardless of testing methodology, using G0431. Presently, labs requiring a CLIA certificate of waiver should continue to bill 80101QW.

A provision in the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 will soon change the policy of who is considered a critical access hospital (CAH) outpatient when outpatient clinical diagnostic laboratory services are provided.

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