CPT® 80307: Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers, chromatography and mass spectrometry either with or without chromatography, includes sample validation when… - JF Part B
CPT® 80307: Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers, chromatography and mass spectrometry either with or without chromatography, includes sample validation when performed, per date of service
In order to fulfill its contractual obligation with CMS, Noridian Healthcare Solutions (Noridian), your Medicare Contractor, performs pre-payment reviews in accordance with CMS direction. CMS is required by the Social Security Act to ensure that payment is made only for those medical services that are reasonable and necessary. Medical review assesses submitted documentation to validate provider compliance with Medicare payment rules and regulations, including coverage, coding and billing guidelines.
This is to update providers of the claim review findings for CPT® 80307; Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers, chromatography and mass spectrometry either with or without chromatography, includes sample validation when performed, per date of service. The results of this focused review are not a reflection on providers' competence as a health care professional or the quality of care provided to patients. Specifically, the results are based on the documentation requested by Medicare and/or your facility's compliance with the required documentation.
The Jurisdiction F, Part B Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of CPT® 80307; Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers, chromatography and mass spectrometry either with or without chromatography, includes sample validation when performed, per date of service. The quarterly edit effectiveness results from July 1, 2024 to September 30, 2024 are as follows:
Top Denial Reasons
- The requested records were not received
- The documentation submitted does not support medical necessity as listed in coverage requirements in the National Coverage Determination or Local Coverage Determination
- The documentation submitted was incomplete and/or insufficient
Educational Resources
- How to Respond to ADR
- Documentation Guidelines for Medicare Services
- LCD - Urine Drug Testing L36707
- Controlled Substance Monitoring and Drugs of Abuse Testing [PDF]
Education
This test may be requested as drug screenings for all drugs and all drug classes performed by the respective technology and process per date of service. In addition, this service encompasses all sample validations performed and may include, but is not limited to, pH, specific gravity, and nitrite. This code is reported for tests performed utilizing instrument chemistry analyzers, such as immunoassay (e.g., EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA), chromatography (e.g., GC, HPLC), and mass spectrometry with or without chromatography (e.g., DART, DESI, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF). Presumptive tests may be confirmed with a definitive test that designates the drug. Specimen type varies. This code should only be reported once per date of service no matter how many procedures or results are performed.
Failure to Return Records
The Internet-Only Manual (IOM) addresses timeframes for submission of records for pre-payment reviews in the Medicare Program Integrity Manual, Publication 100-08, Chapter 3, Section 3.2.3.2.
"When requesting documentation for prepayment review, the MAC and ZPIC shall notify providers that the requested documentation is to be submitted within 45 calendar days of the request. The reviewer should not grant extensions to providers who need more time to comply with the request. Reviewers shall deny claims for which the requested documentation was not received by day 46."
Incomplete And/or Insufficient Documentation
When additional documentation has been requested to verify compliance with the CPT® code billed and the submitted documentation lacks evidence to support that, the claim will be denied as the documentation submitted was incomplete and/or insufficient. Refer to Internet Only Manual (IOM), Publication (Pub) 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8(C)
For additional educational resources, please visit our Education and Outreach department.
