Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Community Health Center Bulletin 74 February 2013 TO: Community Health Centers Participating in MassHealth FROM: Julian J. Harris, M.D., Medicaid Director RE: Drug Screen/Quantitative Drug Test Claim Edit; Drug Screens Performed For Residential Monitoring Drug Screen/Quantitative Drug Tests MassHealth has established new claim edits for quantitative drug tests billed on the same date of service (DOS) as a drug screen service effective for dates of service on or after January 1, 2013. Quantitative drug tests billed on the same DOS as a drug screen service will be denied with explanation of benefits (EOB) code 8304 (lab conflict w/each other on the same day). Primary Procedure Codes G0431 – Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter and/or G0434 – Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter Secondary Procedure Codes 80154 – Benzodiazepines 80299 – Quantification of drug, not elsewhere specified 82055 – Alcohol (ethanol), any specimen except breath 82145 – Amphetamine or methamphetimine 82205 – Baribituates, not elsewhere specified 82520 – Cocaine or metabolite 82570 – Creatinine; other source 82575 – Creatinine; clearance 83840 – Methadone 83925 – Opiate(s), drug and metabolites, each procedure 83992 – Phencyclidine EOB Code/Description 8304 – Lab conflict w/each other on the same day (continued on next page) MassHealth Community Health Center Bulletin 74 February 2013 Page 2 Drug Screen/Quantitative Drug Tests (cont.) Confirmatory drug tests should be billed with procedure code 80102 (drug confirmation, each procedure). Providers must only perform confirmation tests for positive results from a drug screen service on an as- needed basis only when medically necessary. Providers should not bill for quantitative tests in lieu of drug screen services or as a routine supplement to drug screens. Residential Monitoring/Sober Home Requests MassHealth does not pay for drug screen tests performed for residential monitoring purpose since that purpose does not satisfy the requirement that laboratory tests must be medically necessary. This includes requests signed by a MassHealth authorized prescriber, if the purpose of the test is to comply with a sober home’s residential monitoring policy. Please note that sober homes do not meet the definition of an authorized prescriber, as defined in the regulations at 130 CMR 401.402. Laboratory Requests Authorized prescribers must review requests for laboratory tests, which they sign to determine medical necessity as well as ensure the test meets all other relevant payment conditions listed under 130 CMR 450.000, 401.000, and 433.000, and any other applicable requirements. The regulations referenced above are available online at www.mass.gov/masshealth by clicking on the MassHealth Regulations link under the Publications heading on the bottom right side of the MassHealth home page. Providers are reminded that all laboratory services performed by independent clinical laboratories require a written request from an authorized prescriber as defined by regulations at 130 CMR 401.402. Laboratory requests must also meet the requirements listed 130 CMR 401.416, which among other things establishes that standing order requests are limited to 30 days for services related to substance abuse testing and 180 days for all other laboratory services. All services should be medically necessary as defined by 130 CMR 450.204 and not be subject to 130 CMR 401.411 (noncovered services and payment limitations). Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.