Effective for claims processed beginning November 1, 2013, and consistent with Centers for Medicare and Medicaid Services (CMS) guidelines, Harvard Pilgrim will no longer reimburse qualitative drug screen testing for the following CPT codes:
- 80100—Drug screen, qualitative; multiple drug classes chromatographic method, each procedure
- 80101—Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class
- 80104—Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure
Instead, when reporting qualitative drug screens, please use either of the following HCPCS codes:
- G0431—Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter
- G0434—Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter
Harvard Pilgrim only reimburses for screenings that are medically necessary for the purposes of diagnosis and/or treatment and are ordered by an authorized prescriber who is providing treatment to the member.
For additional information, please see the updated Non-Covered Services and the Laboratory & Pathology payment policies.