Policy Updates May 2015

The information outlines updates to policies that are effective this month. To view the updated policy in its entirety, select the policy name.

Policy Name Affected Physicians Updates effective May 15, 2015
Omnibus Reimbursement Policy (R24) – For Qualitative Drug Screen Testing*
  • Outpatient facilities
  • Rehabilitation and substance abuse centers
Consistent with guidelines from the Centers for Medicare & Medicaid Services (CMS) and our Omnibus Reimbursement Policy (R24), all claims for qualitative drug screens that are submitted on a UB04 form will have to be billed using either HCPCS codes G0431 or G0434. These G codes will be eligible for one unit of reimbursement per date of service.
Billing any other codes for these services, including CPT® codes 80300, 80301, 80302, 80303, or 80304, will result in a denial and will not be reimbursed.

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The appearance of an item or procedure in this update indicates only that we have recently adopted or revised a policy. It does not imply that we provide coverage for the items or procedures listed. In the event of an inconsistency or conflict between the information provided below and the posted policy, the provisions of the posted policy will prevail.