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Cigna will be updating their Code Edit Policy with guidelines for Qualitative Drug Screen Testing effective August 19, 2013. This policy is in accordance with recommended updates from the Centers for Medicare & Medicaid (CMS).  With this update, claims submitted under CPT codes 80100, 80101, and 80104 will no longer be reimbursed.        

• CPT codes 80100, 80101, and 80104 should be submitted under the following HCPCS codes:
  • G0431 (Drug screen, qualitative; multiple drug classes by high complexity test method [e.g., immunoassay, enzyme assay] per patient encounter) will be used to report highly complex testing methods – such as multi-channel chemistry analyzers – where a complex instrumented device is required to perform some or all of the screening tests for the patient.
  • G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter) will be used to report simple testing methods – such as dipsticks, cups, cassettes, and cards – that are interpreted visually with the assistance of a scanner, or are read using a moderately complex reader device outside the instrumented laboratory setting.
• Reimbursement for codes G0431 and G0434 will be limited to one unit per single date of service.
• Physicians should only bill for services that they perform themselves. The laboratory performing the tests should submit the claims, not the physician's office ordering the tests.

To view these changes in Cigna's updated Code Edit Policy and Guidelines, log in to CignaforHCP.com and click on "Useful Links" and then "Claim Editing Policies & Procedures".  To become a registered user, go to CignaforHCP.com and click on "Register Now".  If you do not have internet access or would like additional information, call Cigna customer service at 1-800-882-4462.

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