New CMS Edit Impacting Drug Testing Reimbursement CPT 80307 HCPCS G0480-G0483 - Effective July 1, 2023

New CMS Edit Impacting Drug Testing Reimbursement CPT 80307 HCPCS G0480-G0483 - Effective July 1, 2023

I already saw this coming. For the past 5 years, I have made recommendation to my clients that these 2 tests should not be reported considering the timing of each test. It just simply doesn't happen on the same day and much more the result of these tests doesn't happen at the same time. Who's with me with this?

New CMS Edit Impacting Drug Testing Reimbursement CPT 80307 HCPCS G0480-G0483 - Effective July 1, 2023

Key Changes to NCCI PTP Edits for Medical Testing in 2023:

The Centers for Medicare & Medicaid Services (CMS) has made significant updates regarding the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) edits. Here's a concise breakdown of these important changes affecting medical laboratories:

1. Implementation of NCCI PTP Edits:

​Starting from July 1, 2023, CMS introduced NCCI PTP edits which directly affect:

• Presumptive Tests: Specifically targeting Column One codes 80305, 80306, and 80307.
• Definitive Tests: Focusing on Column Two codes G0480 – G0483, and G0659.

2. Limitation on Using NCCI Modifier:
Currently, medical entities cannot override these edits using an NCCI modifier. However, this is about to change.

3. Introduction of the CCMI of 1:
CMS announced a forthcoming modification. The edits will transition to a Correct Coding Modifier Indicator (CCMI) of 1. This significant shift means that providers can utilize a modifier to bypass the edits when the concurrent billing of these codes is deemed appropriate.

4. Determining Bypass Allowance:
When can these codes be billed together using a modifier? This is primarily outlined by the Medicare Administrative Contractors (MACs) in their Local Coverage Determinations.

5. Retroactivity and Implementation:
The acceptance of the modifier for bypassing will be retroactive, dating back to July 1, 2023. Come October 1, 2023, in their next quarterly update, the Medicare claims processing systems will reflect this change.

6. Guidance for Laboratories:

During the transition period:

• If labs bill the MACs for these tests together post-July 1, 2023, and deem that an NCCI modifier is suitable, they should incorporate the relevant modifier in their claim.
• MACs will subsequently amend those claims dated between July 1 and October 1, 2023, to permit payment where an NCCI modifier was employed.

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Laboratories also have the option to initiate the MAC appeals process if they prefer not to await the auto-adjustment. Alternatively, they can hold off on their claims submissions until CMS enforces the change.
In essence, these modifications herald a more flexible approach to coding and billing, providing medical entities with more options and clearer pathways for claim submissions and adjustments.