CQW Panacea-re-brand-rev3

Laboratory

For the Week of March 23, 2015

Question:

When will CMS post the CLFS payments for the new drug-assay codes?

Answer:

There will be no Medicare payment for the 63 new 2015 drug-assay codes (80300–80377) in the foreseeable future. According to the Centers for Medicare & Medicaid Services (CMS), the reason is due to its “long-standing concerns about the potential for fraudulent and abusive billing of drugs tests.”

In its October 2014 announcement of this decision, CMS stated that it was concerned that “the structure of the new drug testing codes may not prevent abusive billing.” CMS believes that the potential for overpayment exists when each individual drug test is billed rather than a single code that pays the same amount regardless of the number of drugs being tested.

In a statement announcing this decision, CMS stated, “We continue to believe that we need additional time and input from the public to determine Medicare payment for drugs of abuse testing that will not lead to overpayment.”

 

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