September 14, 2015

State of Alabama
Press Release: Medicaid

Claims for Drug Testing Performed in Providers’ Offices

PDF Version

TO:  Physicians, Rural Health Clinics, and FQHCs
 

Effective for claims with dates-of-service of January 1, 2015, and after, Alabama Medicaid will cover CMS HCPCS G-codes (G0434 and G6058).  A QW modifier must be used for crossover claims.  The coverage will permit payment of claims submitted by providers with a valid CLIA certificate.   

 

·         HCPCS code G0434 will cover one drug screen, regardless of the number of drugs or classes, procedure(s)/methodology (ies), any source(s), per appropriately billed date of service. (Only one claim per date of service will be paid regardless of the number of drug screens performed.) 

 

·         HCPCS code G6058 will cover drug one test (confirmatory and/or definitive, qualitative and quantitative), regardless of the number of drugs or drug classes, procedure(s)/methodology (ies), source(s), including  sample validation. (Only one appropriately billed claim per date of service will be paid regardless of the number of confirmatory and/or definitive, qualitative and quantitative drug tests performed.)

 

These codes will remain in effect until CMS creates new G-codes, modifies and publishes its new drug test policy, or until notified otherwise. Providers may resubmit drug test screening claims which were denied in 2015 for CLIA indicator reasons. If any other reason exists for the denial either in part or as the entire reason, the claim may not be resubmitted. Resubmitted claims should use the appropriate G-code above (use the “QW” modifier with crossover claims only).  If there are any questions concerning this matter, providers may contact Russell Green at (334) 242-5554, or (334) 353-5017, by email at Russell.Green@medicaid.alabama.gov.      



  • For more information, visit http://medicaid.alabama.gov
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