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CMS Transmittals




G0479
Quick jump to procedure code: Printer Friendly Version
G0481

Procedure Category: Pathology and Laboratory
Procedure Subcategory: Definitive Drug Testing (Medicare)

G0480: Drug test def 1-7 classes

HCPCS
G0480: Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed


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2018 Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State
2018 Laboratory Fee Schedule: $114.43


2018 OPPS Status Indicator: Q4

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Percentage
ICD-10 Code
Description
Related DRG(s)
28.2%
Z79.891
Long term (current) use of opiate analgesic
949-950
19.6%
Z79.899
Other long term (current) drug therapy
949-950
15.2%
F11.20
Opioid dependence, uncomplicated
894-897
4.3%
G89.4
Chronic pain syndrome
091-093
3.5%
Z51.81
Encounter for therapeutic drug level monitoring
945-946
949-950
3.3%
M54.5
Low back pain
551-552
2.6%
F19.20
Other psychoactive substance dependence, uncomplicated
894-897
1.9%
G89.29
Other chronic pain
091-093
1.6%
F10.20
Alcohol dependence, uncomplicated
894-897
0.8%
M54.16
Radiculopathy, lumbar region
551-552

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

G0480 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering G0480

CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report-New

Column 1 CCI Edits for G0480
Denied Codes (1)
Effective
Modifier
Accepted (2)
80320 DRUG SCREEN QUANTALCOHOLS
10/01/2017 No
80321 ALCOHOLS BIOMARKERS 1OR 2
10/01/2017 No
80322 ALCOHOLS BIOMARKERS 3/MORE
10/01/2017 No
80323 ALKALOIDS NOS
10/01/2017 No
80324 DRUG SCREEN AMPHETAMINES 1/2
10/01/2017 No
80325 AMPHETAMINES 3OR 4
10/01/2017 No
80326 AMPHETAMINES 5 OR MORE
10/01/2017 No
80327 ANABOLIC STEROID 1 OR 2
10/01/2017 No
80328 ANABOLIC STEROID 3 OR MORE
10/01/2017 No
80329 ANALGESICS NON-OPIOID 1 OR 2
10/01/2017 No
80330 ANALGESICS NON-OPIOID 3-5
10/01/2017 No
80331 ANALGESICS NON-OPIOID 6/MORE
10/01/2017 No
80332 ANTIDEPRESSANTS CLASS 1 OR 2
10/01/2017 No
80333 ANTIDEPRESSANTS CLASS 3-5
10/01/2017 No
80334 ANTIDEPRESSANTS CLASS 6/MORE
10/01/2017 No
80335 ANTIDEPRESSANT TRICYCLIC 1/2
10/01/2017 No
80336 ANTIDEPRESSANT TRICYCLIC 3-5
10/01/2017 No
80337 TRICYCLIC & CYCLICALS 6/MORE
10/01/2017 No
80338 ANTIDEPRESSANT NOT SPECIFIED
10/01/2017 No
80339 ANTIEPILEPTICS NOS 1-3
10/01/2017 No
80340 ANTIEPILEPTICS NOS 4-6
10/01/2017 No
80341 ANTIEPILEPTICS NOS 7/MORE
10/01/2017 No
80342 ANTIPSYCHOTICS NOS 1-3
10/01/2017 No
80343 ANTIPSYCHOTICS NOS 4-6
10/01/2017 No
80344 ANTIPSYCHOTICS NOS 7/MORE
10/01/2017 No
80345 DRUG SCREENING BARBITURATES
10/01/2017 No
80346 BENZODIAZEPINES1-12
10/01/2017 No
80347 BENZODIAZEPINES 13 OR MORE
10/01/2017 No
80348 DRUG SCREENING BUPRENORPHINE
10/01/2017 No
80349 CANNABINOIDS NATURAL
10/01/2017 No
80350 CANNABINOIDS SYNTHETIC 1-3
10/01/2017 No
80351 CANNABINOIDS SYNTHETIC 4-6
10/01/2017 No
80352 CANNABINOID SYNTHETIC 7/MORE
10/01/2017 No
80353 DRUG SCREENING COCAINE
10/01/2017 No
80354 DRUG SCREENING FENTANYL
10/01/2017 No
80355 GABAPENTIN NON-BLOOD
10/01/2017 No
80356 HEROIN METABOLITE
10/01/2017 No
80357 KETAMINE AND NORKETAMINE
10/01/2017 No
80358 DRUG SCREENING METHADONE
10/01/2017 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
80359 METHYLENEDIOXYAMPHETAMINES
10/01/2017 No
80360 METHYLPHENIDATE
10/01/2017 No
80361 OPIATES 1 OR MORE
10/01/2017 No
80362 OPIOIDS & OPIATE ANALOGS 1/2
10/01/2017 No
80363 OPIOIDS & OPIATE ANALOGS 3/4
10/01/2017 No
80364 OPIOID &OPIATE ANALOG 5/MORE
10/01/2017 No
80365 DRUG SCREENING OXYCODONE
10/01/2017 No
80366 DRUG SCREENING PREGABALIN
10/01/2017 No
80367 DRUG SCREENING PROPOXYPHENE
10/01/2017 No
80368 SEDATIVE HYPNOTICS
10/01/2017 No
80369 SKELETAL MUSCLE RELAXANT 1/2
10/01/2017 No
80370 SKEL MUSC RELAXANT 3 OR MORE
10/01/2017 No
80371 STIMULANTS SYNTHETIC
10/01/2017 No
80372 DRUG SCREENING TAPENTADOL
10/01/2017 No
80373 DRUG SCREENING TRAMADOL
10/01/2017 No
80374 STEREOISOMER ANALYSIS
10/01/2017 No
80375 DRUG/SUBSTANCE NOS 1-3
10/01/2017 No
80376 DRUG/SUBSTANCE NOS 4-6
10/01/2017 No
80377 DRUG/SUBSTANCE NOS 7/MORE
10/01/2017 No
80500 LAB PATHOLOGY CONSULTATION
04/01/2016 Yes
80502 LAB PATHOLOGY CONSULTATION
04/01/2016 Yes
81000 URINALYSIS NONAUTO W/SCOPE
04/01/2016 Yes
81001 URINALYSIS AUTO W/SCOPE
04/01/2016 Yes
81002 URINALYSIS NONAUTO W/O SCOPE
04/01/2016 Yes
81003 URINALYSIS AUTO W/O SCOPE
04/01/2016 Yes
81005 URINALYSIS
04/01/2016 Yes
82542 COL CHROMOTOGRAPHY QUAL/QUAN
04/01/2016 Yes
82570 ASSAY OF URINE CREATININE
04/01/2016 Yes
83516 IMMUNOASSAY NONANTIBODY
04/01/2016 Yes
83518 IMMUNOASSAY DIPSTICK
04/01/2016 Yes
83519 RIA NONANTIBODY
04/01/2016 Yes
83520 IMMUNOASSAY QUANT NOS NONAB
04/01/2016 Yes
83789 MASS SPECTROMETRY QUAL/QUAN
04/01/2016 Yes
83986 ASSAY PH BODY FLUID NOS
04/01/2016 Yes
83992 ASSAY FOR PHENCYCLIDINE
10/01/2017 No
84156 ASSAY OF PROTEIN URINE
04/01/2016 Yes
84311 SPECTROPHOTOMETRY
04/01/2016 Yes
G0659 Drug test def simple all cl
10/01/2017 No
(1) These codes will be denied when submitted for payment on the same date of service as G0480.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for G0480

Denied Codes (1)
Effective
Modifier
Accepted (2)
0006U RX MONITORING 120+ DRUGS AND SUBSTANCES
01/01/2018 No
0007U RX TEST PRESUMPTIVE URINE W/DEF CONFIRMATION
01/01/2018 No
0011U RX MNTR DRUGS PRESENT LC-MS/MS ORAL FLUID PR DOS
01/01/2018 No
0020U RX TEST PRESUMPTIVE URINE W/DEF CONFIRMATION
07/01/2018 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
G0481 Drug test def 8-14 classes
04/01/2016 No
G0482 Drug test def 15-21 classes
04/01/2016 No
G0483 Drug test def 22+ classes
04/01/2016 No
(1) These codes will be denied when submitted for payment on the same date of service as G0480.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


2018 Medically Unlikely Edits for G0480


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Code Descriptor / CPT Instruction Code Descriptor / CPT Instruction Not Listed

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   G0480 Top 5 Ordering Providers National* - Extended NPI Market Analysis Search
BENJAMIN JOHNSON -TULLAHOMA,TN 3,551
ALI EL-MOHANDES -HAGERSTOWN,MD 2,851
MUKARRAM KHAN -CINCINNATI,OH 1,968
MICHAEL DALY -GLEN BURNIE,MD 1,875
FRANK HACKL -TULSA,OK 1,774

   G0480 Top 5 Ordering Organizations National*
MILLENNIUM HEALTH, LLC-CA 39,954
DOMINION DIAGNOSTICS LLC-RI 35,829
QUEST DIAGNOSTICS MASSACHUSETTS LLC-MA 29,288
AEGIS SCIENCES CORPORATION-TN 23,906
ALERE TOXICOLOGY SERVICES, INC-TX 19,158

*Based on 2016 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for G0480*         Hide this section.



Annual Performed / Denied


Total National Services (all modifiers) Submitted 2017: 1,048,947
Total Services Denied 2017: 164,937 (15.7%)
National Charges Submitted 2017: $390,661,614.83
National Charges Allowed 2017: $101,722,103.03
National Average (No Modifier) Fee Submitted 2017: $411.28
National Average (No Modifier) Fee Allowed 2017: $115.21
National Average (QW) Fee Submitted 2017: $146.00
National Average (QW) Fee Allowed 2017: $ 0.00


Top 5 Performing Specialties 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Clinical laboratory
(billing independently)
872,199 83.1% $374.27 149,019 17.1%
Interventional Pain Management
(IPM)
(eff. 4/1/03)
46,833 4.5% $470.95 2,444 5.2%
Anesthesiology 29,627 2.8% $426.68 2,042 6.9%
Pain Management
(eff. 1/1/02)
21,877 2.1% $375.70 1,368 6.3%
Nurse practitioner 19,537 1.9% $256.73 1,813 9.3%

Top 5 Places of Service 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Independent laboratory 867,471 82.7% $375.05 147,929 17.1%
Office 180,837 17.2% $360.31 16,783 9.3%
Home 224 0.0% $381.34 63 28.1%
Urgent Care Facility (eff. 1/1/03) 130 0.0% $242.18 23 17.7%
Assisted Living Facility 72 0.0% $ 79.69 9 12.5%

Top 5 Modifiers Submitted 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 788,812 75.2% $411.28 106,347 13.5%
90 - Reference (Outside) Laboratory 249,178 23.8% $252.79 51,377 20.6%
GA - Advanced Beneficiary Notice (ABN) on File 5,430 0.5% $203.98 3,490 64.3%
GZ - Service Expected to be Denied as Not Reasonable and Necessary 3,055 0.3% $337.77 3,055 100.0%
59 - Distinct Procedural Service 1,102 0.1% $210.41 330 29.9%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


   CodeMap Compliance Briefings: Hide this section.

CMS Transmittals Referencing "G0480"
Issue DateTransmittalTitle
2018-03-29 SE18001 Proper Coding for Specimen Validity Testing Billed in Combination with Drug Testing
2017-12-15 R3934CP Calendar Year (CY) 2018 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment


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10/19/2018 11:16:17 54.224.150.24

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