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December 2016 Texas Medicaid Provider Procedures Manual

Radiology and Laboratory Services Handbook : 2 Independent Laboratory : 2.2 Services, Benefits, Limitations, and Prior Authorization : 2.2.8 Drug Testing and Therapeutic Drug Assays

The following procedure codes for drug testing and therapeutic drug assays may be reimbursed by Texas Medicaid:
Providers are encouraged to reference the American Board of Internal Medicine (ABIM) Foundation’s “Choosing Wisely” lists to determine appropriateness of laboratory tests.
Procedure codes G0477, G0478, G0479, G0480, G0482, and G0483 are limited to once per day by any provider.
The following CPT Drug Assay procedure codes will be denied when billed on the same date of service, by the same provider with the corresponding HCPCS Drug Assay procedure codes identified with an "X":
CPT Drug Assay Procedure Codes
The "80000" CPT procedure codes will be denied if they are billed with a corresponding HCPCS "G" code as indicated with an "X" below:
(Blank) There is no relationship between the "80000" CPT procedure code and the HCPCS "G" procedure code. Both procedure codes may be reimbursed if billed with the same date of service.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.