HCPCS “G” Codes Drug Testing
The Centers for Medicare and Medicaid Services (CMS) currently does not recognize AMA CPT(R) drug testing codes (80300-80377) anymore. Therefore, Medicare payers require the claims to be submitted for drug testing with dedicated HCPCS “G” Codes.
For 2016, CMS deleted definitive drug testing codes G6030-G6058 and replaced them with a handful of new codes:
- G0477 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg immunoassay) capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.
- G0478 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg immunoassay) read by instrument-assisted direct optical observation (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.
- G0479 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers (eg, immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service.
- G0480 Drug test(s), definitive, utilizing 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 13 tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed.
- G0481 Drug test(s), definitive, utilizing 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 (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed.
- G0482 Drug test(s), definitive, utilizing 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 (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed.)
- G0483 Drug test(s), definitive, utilizing 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 (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed.
The codes differentiate between presumptive testing ie is a drug present and definitive testing ie to provide a positive identification of the substance in question.
When reporting services, only one of the three presumptive G codes should be reported per day. Similarly, only a single definitive G code should be reported, per day.
For definitive testing, the unit used to determine the appropriate definitive G code to bill is ?drug class.?
CPT(R) defined drug classes include:
- Alcohol(s)
- Alcohol Biomarkers
- Alkaloids, not otherwise Specified
- Amphetamines
- Anabolic steroids
- Analgesics, non-opioid
- Antidepressants, serotonergic class
- Antidepressants, Tricyclic and other cyclicals
- Antidepressants, not otherwise specified
- Antiepileptics, not otherwise specified
- Antipsychotics, not otherwise specified
- Barbiturates
- Benzodiazepines
- Buprenorphine
- Cannabinoids, natural
- Cannabinoids, synthetic
- Cocaine
- Fentanyls
- Gabapentin, non-blood
- Heroin metabolite
- Ketamine and Norketamine
- Methadone
- Methylenedioxyamphetamines
- Methylphenidate
- Opiates
- Opioids and opiate analogs
- Oxycodone
- Phencyclidine
- Pregabalin
- Propoxyphene
- Sedative Hypnotics (nonbenzodiazepines)
- Skeletal muscle relaxants
- Stereoisomer (enantiomer) analysis
- Stimulants, synthetic
- Tapentadol
- Tramadol
- Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified;
Each drug class must be used once per day.
CPT(R) is a trademark of the American Medical Association