Does G0480 require prior authorization?

No, G0480 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0480?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`G0480`, Drug test(s), definitive, utilizing (1) drug identification methods able to

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical necessity for each test must be documented in the patient's medical record as required by LCD L35006.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
All documentation must be maintained in the patient medical record, be legible, include patient identification and the identity of the physician or non-physician practitioner responsible for care, and be available to the contractor upon request.
Medical record documentation maintained by the ordering/treating physician must indicate the medical necessity and clinical indication(s) that led to ordering the drug test and support the selected diagnosis and CPT/HCPCS code(s).

Key Coverage Criteria

Urine drug testing (UDT) and drugs-of-abuse testing are covered when reasonable and necessary per LCD L35006 and ordered on an individual patient basis by the treating clinician with medical-record documentation of medical necessity.
Patients with a documented diagnosis consistent with substance use disorder (SUD) may qualify for an exception to the standard presumptive UDT annual limits.
Urine, blood, or oral fluid specimens may be used for drug testing, with urine preferred for broad screening of common drugs.
Medicare Part B will pay for drug screening services when all coverage criteria, limitations, and medical necessity requirements of LCD DL34645 are met.
Claims for drug screening services are payable under Medicare Part B only in these places of service: office (11), urgent care (20), independent clinic (49), federally qualified health center — freestanding (50), rural health clinic — freestanding (72), and independent laboratory (81).
Controlled substance monitoring and drugs-of-abuse testing are covered when individually ordered by the treating clinician and meet the reasonable and necessary requirements specified in LCD L36393.

20 Active Policies

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J18-L36029, Urine Drug Testing

J18

A56915, Billing and Coding: Urine Drug Testing

WPS-J5-L34645, Urine Drug Testing

NGS-J6-L39611, Urine Drug Testing

A59416, Billing and Coding: Urine Drug Testing

WPS-J8-L34645, Urine Drug Testing

A57077, Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing

FIRST_COAST-L36393, Controlled Substance Monitoring and Drugs of Abuse Testing

NORIDIAN-JE-L36668, Urine Drug Testing

NORIDIAN-JF-L36668, Urine Drug Testing

NOVITAS-JH-L35006, Controlled Substance Monitoring and Drugs of Abuse Testing

PALMETTO-JJ-L35724, Urine Drug Testing

NGS-JK-L39611, Urine Drug Testing

NOVITAS-JL-L35006, Controlled Substance Monitoring and Drugs of Abuse Testing

A56645, Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing

PALMETTO-JM-L35724, Urine Drug Testing

BCBSIL-MED207.154, Drug Testing in Pain Management and Substance Use Disorder Treatment

BCBSMT-MED207.154, Drug Testing in Pain Management and Substance Use Disorder Treatment

BCBSNM-MED207.154, Drug Testing in Pain Management and Substance Use Disorder Treatment

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G0480, Drug test(s), definitive, utilizing (1) drug identification methods able to

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical necessity for each test must be documented in the patient's medical record as required by LCD L35006.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
All documentation must be maintained in the patient medical record, be legible, include patient identification and the identity of the physician or non-physician practitioner responsible for care, and be available to the contractor upon request.
Medical record documentation maintained by the ordering/treating physician must indicate the medical necessity and clinical indication(s) that led to ordering the drug test and support the selected diagnosis and CPT/HCPCS code(s).

Key Coverage Criteria

Urine drug testing (UDT) and drugs-of-abuse testing are covered when reasonable and necessary per LCD L35006 and ordered on an individual patient basis by the treating clinician with medical-record documentation of medical necessity.
Patients with a documented diagnosis consistent with substance use disorder (SUD) may qualify for an exception to the standard presumptive UDT annual limits.
Urine, blood, or oral fluid specimens may be used for drug testing, with urine preferred for broad screening of common drugs.
Medicare Part B will pay for drug screening services when all coverage criteria, limitations, and medical necessity requirements of LCD DL34645 are met.
Claims for drug screening services are payable under Medicare Part B only in these places of service: office (11), urgent care (20), independent clinic (49), federally qualified health center — freestanding (50), rural health clinic — freestanding (72), and independent laboratory (81).
Controlled substance monitoring and drugs-of-abuse testing are covered when individually ordered by the treating clinician and meet the reasonable and necessary requirements specified in LCD L36393.

20 Active Policies

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J18-L36029, Urine Drug Testing

J18

A56915, Billing and Coding: Urine Drug Testing

WPS-J5-L34645, Urine Drug Testing

NGS-J6-L39611, Urine Drug Testing

A59416, Billing and Coding: Urine Drug Testing

WPS-J8-L34645, Urine Drug Testing

A57077, Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing

FIRST_COAST-L36393, Controlled Substance Monitoring and Drugs of Abuse Testing

NORIDIAN-JE-L36668, Urine Drug Testing

NORIDIAN-JF-L36668, Urine Drug Testing

NOVITAS-JH-L35006, Controlled Substance Monitoring and Drugs of Abuse Testing

PALMETTO-JJ-L35724, Urine Drug Testing

NGS-JK-L39611, Urine Drug Testing

NOVITAS-JL-L35006, Controlled Substance Monitoring and Drugs of Abuse Testing

A56645, Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing

PALMETTO-JM-L35724, Urine Drug Testing

BCBSIL-MED207.154, Drug Testing in Pain Management and Substance Use Disorder Treatment

BCBSMT-MED207.154, Drug Testing in Pain Management and Substance Use Disorder Treatment

BCBSNM-MED207.154, Drug Testing in Pain Management and Substance Use Disorder Treatment

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about G0480 Sign up free

`G0480`, Drug test(s), definitive, utilizing (1) drug identification methods able to

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G0480`, Drug test(s), definitive, utilizing (1) drug identification methods able to

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G0480, Drug test(s), definitive, utilizing (1) drug identification methods able to

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G0480, Drug test(s), definitive, utilizing (1) drug identification methods able to

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G0480`, Drug test(s), definitive, utilizing (1) drug identification methods able to

`G0480`, Drug test(s), definitive, utilizing (1) drug identification methods able to