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, 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 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.