Presumptive Drug Testing

Presumptive drug testing services may be performed prior to definitive drug screen testing (80320-80377), when a provider wants to rule out illicit drug uses or to confirm the presence of a particular drug class without identifying individual drugs; or, to distinguish between structural isomers. For example, a patient using prescription opioids for pain management may receive a randomized drug screen service to test for the presence of opioids and illicit drugs, or other prescription drugs that may cause risk when combined with opioids (e.g., benzodiazepines).

Presumptive Drug Testing CPT Codes

Medicare and private payers require the same codes to report presumptive drug testing:

80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges) includes sample validation when performed, per date of service (Old G0477)

80306 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); read by instrument assisted direct optical observation only (eg, dipsticks, cups, cards, cartridges) includes sample validation when performed, per date of service (Old G0478)

80307 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures, by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed per date of service (Old G0479)

According to CPT® guidelines, sample validation in each of the codes “may include, but are not limited to, pH, specific gravity, and nitrite.” Because these sample validation tests are included in presumptive drug testing, urinalysis, immunoassay tests, and other lab tests will bundle into presumptive drug testing codes, by definition. Do not append modifier 59 Distinct procedural service, XE Separate encounter, XP Separate practitioner, XS Separate structure, or XU Unusual non-overlapping service to override the bundling combination. Chapter 10 of the National Correct Coding Initiative (NCCI) Policy Manual confirms that providers should not separately report the validity testing. CPT® also limits each of these codes to one unit, per billing.

Definitive Drug Testing

Codes 80320-80377 report definitive drug testing of specific type(s) of drug(s) such as alcohol, amphetamines, and anabolic steroids, as well as drugs or substances that are not otherwise specified. The Definitive Drug Classes Listing is used to identify drugs and metabolites included in each definitive drug class.

MLN Matters Number: SE18001, “Proper Coding for Specimen Validity Testing Billed in Combination with Drug Testing ,” reminds us that for Medicare, definitive drug testing is reported using dedicated HCPCS codes, rather than CPT® 80320-80377. SE18001 explains:

These codes differ based on the number of drug classes including metabolites tested. Only one code from this code range may be reported per date of service.

  • G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed

  • G0481 …8-14 drug class(es), including metabolite(s) if performed

  • G0482 …15-21 drug class(es), including metabolite(s) if performed

  • G0483 …22 or more drug class(es), including metabolite(s) if performed

Additionally, the Centers for Medicare & Medicaid Services (CMS) created definitive drug testing code G0659 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem), excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes, “for laboratories performing a less sophisticated version of these tests than is usually performed in drug testing laboratories.”

Per CMS, the work performed in G0659 “approximates the work performed in CPT code 80307.”