For all charges incurred on or after Jan 1, 2016, HealthChoice covers qualified laboratory urine drug screenings one time per day per patient. As a reminder for all charges incurred on or after April 1, 2015, HealthChoice covers only the following laboratory urine drug screens when medically necessary screening tests are required:
- 80300 – Drug Screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures (e.g., immunoassay) capable of being read be direct optical observation, including instrument-assisted when performed (e.g., dipsticks, cups, cards, cartridges), per date of service.
- G0434 – Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter.
Clinical editing applies.
Note: No other definitive Drug Testing and Presumptive Drug Class Screening CPT codes are covered through June 30, 2016.
For charges incurred on or after July 1, 2016, HealthChoice will cover the following presumptive (qualitative) and definitive (quantitative) laboratory urine drug screenings when medically necessary. Laboratory screening and confirmation services are covered under the HealthChoice medical plan, subject to deductible, coinsurance, out-of-pocket maximums, clinical editing and all policy provisions.
- Presumptive (qualitative) laboratory urine drug screenings are limited to 12 total per calendar year and certification is not required.
- 80300 DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES
- G0477 DRUG TST PRESUMP; CPBL BEING READ DC OPT OBV ONLY
- G0478 DRUG TEST PRESUMP; READ BY INSTRUM-AST DC OPT OBV
- G0479 DRUG TEST PRESUMP; INSTRUMENTED CHEMISTRY ANLYZER
- Definitive (quantitative) laboratory urine drug screenings are limited to four total per calendar year and certification is not required.
- G0480 DRUG TEST DEFINITV DR ID METH P DAY 1-7 DRUG CL
- G0481 DRUG TEST DEFINITV DR ID METH P DAY 8-14 DRUG CL
- G0482 DRUG TEST DEFINITV DR ID METH P DAY 15-21 DR
- G0483 DRUG TST DEFINITV DR ID METH P DAY 22/MORE DR CL
If you have any questions regarding this change, please contact our medical claims administrator.