Category: Drug Testing

The AMA CPT code for drug testing using our 12 panel drug test cups, which is the code used for Medicare B and most other insurers in 2023, is 80305.

The American Medical Association (AMA) CPT code for drug testing 80305 replaces older codes used for presumptive drug testing read by direct optical observation. 80305 is now recognized as the CMS HCPCS code in place of G0477.  Provider must include sample validation (observing specimen donation and confirming temperature) at the time of collection.

The codes for onsite drug testing were changed from an earlier healthcare standard in 2019 and haven’t been changed since. Not all insurance companies will reimburse for drug testing. Medicaid will not reimburse.

The AMA text of the presumptive drug testing code reads as follows

CPT code 80305: Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g. immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.

Medicare does not pay out for this code because they do not consider it to be medically necessary. A physician is sill responsible for determining that narcotic drugs are not being abused, misused or trafficked.

Private insurance pays up to $21 for this service (office fees on average are approximately $60). The office fee for a presumptive drug test read optically including sample validation should be higher (one office charged a fee of $290), but reimbursement is usually about $22.

This new code 80305 replaced 80300 & G0477 and has been in effect since January 1, 2017.

 

Other Valid CPT Codes for Drug Testing

The other valid codes for drug testing patients are 80306 & 80307.

AMA CPT code for drug testing 80306 is for a presumptive test with specimen validation that is read by instrument assisted direct optical observation. Some suppliers sell machines that are used with their tests to provide a presumptive result to assist in human interpretation.

AMA CPT code for drug testing 80307 is for a presumptive drug testing through the use of instrument chemistry analyzers. This includes immunoassay, chromatography, and mass spectrometry.

Any patient that has a prescription for a narcotic or heavily abused non-narcotic drug should be given a urine drug screen prior to prescribing. It is up to the doctor which method is appropriate. The advantages to using point of care drug tests that are CLIA waived and can be read by staff and the results are immediate.

We suggest that positive tests are sealed and sent to a lab and confirmed with the use of instruments.

According to Palmetto GBA providers may ONLY perform and report one type of presumptive urine drug testing per patient. If you have a positive result send the sample in the cup for confirmation and charge for the appropriate CPT code for that service.

Tips for Successful Claim Submission for Drug of Abuse Testing

• Include supporting documentation that shows the provider asking for a drug screen.
• The patient’s medical record must support the use of all treatment codes.
• The ordering physician must maintain documents indicating the medical necessity for performing a drug test.
• Observe specimen donation to validate the authenticity of the sample.
• Make sure your cups are CLIA waived, or that your employee administering the tests has proper certification
• Make sure the wording for the service reported on the claim matches wording for the service ordered by the physician.
• Each code represents all drugs and can be reported only once per date of service no matter how many devices were used.
• A maximum of one presumptive urine drug test may be submitted and paid for each date of service. You cannot charge for an optically read test and again for a lab’s confirmation.
• Specimen validity testing is not eligible to be separately billed under any procedure code, and is expected to be completed as part of testing.

Use our employee drug testing guide to help inform your policies and procedures when testing new hires and completing random drug testing in house.

Procedure

1. Donor provides urine specimen in the cup and screws the cap on.
2. Operator checks the cap for tightness, starts timer
3. Remove peel off label
4. Check temperature strip on back. A green color will appear to indicate the temperature, proper range is 90°-100°F
5. At 5 minutes read the results. Presence or absence of drugs is indicated by the colored bands in the results area.

 

Tips for Successful Employee Drug Testing

Set Standard Drug Testing Procedures

When starting an employee drug testing program you need to begin with a consistent operating procedure that is detailed in a manual. Outline whether drug testing will be completed on a random basis or whether the company will only drug test employees after accidents and when they’re suspected of being intoxicated on the job.

During the hiring process management or human resources should have every new employee sign a Drug Testing Compliance form that clearly outlines the rights and responsibilities of every employee as it pertains to the company drug testing policy.  This will help in the unlikely event a terminated employee engages in legal action.

Always Observe Urine Drug Screens
When your patient or employee knows they are going to fail a drug test they will try anything to get around it. If you aren’t observing a drug screen then you can never definitively say that your subject didn’t substitute a clean sample for their own urine. One study found that when staff at an outpatient rehab started witnessing drug screens positive results almost doubled from 25% to 42%.

Most facilities that do frequent point of care drug screening will have a bathroom that is specifically designed for observing drug screens. Toilet water will be dyed blue, doors will be removed from stalls, sink access will be restricted, and a mirror will be placed for an observer to confirm that the sample did indeed come from the patient and not a small bottle concealed in their underwear.

Always Send Positive Drug Screen Samples to a Lab
Point of care drug screening is meant to lower the cost of a company drug testing program, but was never intended to replace confirmation from a licensed laboratory.

A drug testing cup can only indicate that a subject has levels of a certain metabolite in their urine that is above a designated cutoff. It doesn’t give any indication of the amount of that metabolite, the time frame when drug use likely occurred, the amount of drugs used or even the source of the metabolite.

A positive drug screen in your office just means that subject has likely used drugs in the past few days and their sample should be sent to a lab for confirmation. Besides the fact that a point of care test only indicates quantities of a metabolite above or below a designated cutoff, the possibilities of a false positive or faulty test means that you run the liability of making a bad decision based on evidence that doesn’t meet a burden of proof.

Maintain a Secure Chain of Custody

From the time you collect the sample from an employee you are responsible for making sure that the sample is not adulterated or otherwise tampered with until a laboratory can confirm the results.

Take the employee to a designated waiting area where you can set the collection cup and wait for the test strips to indicate whether a sample is positive or negative. It is important to have the employee wait with you so they can confirm that you have not tampered with their sample.

If the sample comes back positive you will need to seal it, package it and fill out paperwork to send it to a lab. Until the sample is properly packaged you should not let it out of your sight, and do not leave the package unattended until you pass custody on to the shipping agency.

It’s very unlikely that an employee that had a legitimate positive drug screen will pursue legal action, but you should treat every case as if you plan on being deposed in court. An employee that is the victim of a false positive will appreciate your diligence in maintaining strict control of their specimen so their innocence can be proven by the lab.

Store Unused Drug Tests in a Cool Controlled Environment

Test strips depend on chemicals present in the strips to react to metabolites of the target substance.

If you remember your science class in high school, every experiment called for a high level of control of different variables so the only variable being tested was directly related to the hypothesis you were trying to prove. In drug testing the uncontrolled variable is the amount of drugs each subject has consumed recently; all other variables need to be tightly controlled.

Extremely high or low temperatures can cause the chemicals in the test strips to alter their molecular structure which will lead to a different reaction to the target metabolites.

We take special precautions to make sure that our tests are stored at 70 degrees Fahrenheit in our facilities and choose the quickest shipping methods to limit exposure to uncontrolled temperatures during transport. Even in a controlled environment be careful not to store tests in direct sunlight which can raise the temperature of the tests even though the room is controlled.

Detect Dilution of Urine Samples

One of the most common techniques employees and patients use to alter drug screen results is diluting their urine in their own body by drinking excessive amounts of water or tea prior to testing. This can cut detection times down tremendously.

Doctors have long recommended that adults drink 4-8 glasses of water everyday; a healthy adult male should have urine that is colored like light lemon juice – a slight yellow tint. If a subject has urine that is completely clear it is acceptable to ask that they give another sample in 2-4 hours while not consuming more liquids.

 

 

Instruct any subject that consistently provides diluted samples that further dilution will result in a failed screen, or use an alternate sample (blood, saliva or hair follicle) at the employee’s expense.