80307 CPT code

80307 CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Examples 

80307 CPT code is coded for Presumptive Drug Class Screening Procedures. The CPT codes 80305-80307, G0480–G0483, and code G0659 are a group of procedure codes used when a physician performs Drug Class Screening Procedures.

80307 CPT Code Description

Drug class screening procedures help rule out the usage/intake of controlled substances and illicit drugs. These are precautionary screening tests ordered by the physician before prescribing any medication that may interfere with the pre-consumed controlled substances or other types of drugs. The lab technician performs drug class screening procedures with the help of instrumented chemistry analyzers. 

There are two types of drug screening procedures – presumptive and definitive. 

Presumptive drug screening:

Presumptive drug screening is a rapid test that provides an instant result to the physician. This procedure tests the presence or absence of certain types of drugs in the patient’s body. The result obtained is either positive or negative. This is not a quantitative test.

As the name suggests, this kind of screening is not highly reliable. However, it can be used when emergency actions are required. A definitive test is taken to confirm the result of a presumptive test that provides a more reliable and accurate result.

Presumptive drug tests may not adequately detect synthetic opioids, some benzodiazepines, or other synthetic drugs. 

A presumptive drug test may not produce accurate results when testing for certain types of benzodiazepines and synthetic opioids. Such tests may report a false negative. The CPT codes from 80305-80307 are used to code presumptive drug screening. 

Definitive drug screening:

Any false negative or false positive result obtained from a presumptive drug screening can be overwritten with the help of a Definitive drug screening. In addition, a physician may order a Definitive drug screening immediately after a Presumptive test to double-check the result.

Moreover, a Definitive drug screening can also help to find the presence of a specific class of drug and measure its amount. Hence a Definitive drug screening can be used to perform quantitative analysis. The CPT codes G0480-G0483 and G0469 are used for definitive drug screening. 

Direct-to-definitive drug test:

A physician may request a definitive drug test without performing a presumptive drug test. Suppose the physician knows in advance the inadequacy of information that could be derived from a presumptive drug screen.

In that case, he/she might order a definitive drug test directly. This is highly case-specific as the provider might need detailed reports from any sample. In such cases, presumptive drug tests may not be required, and they are bypassed. 

A direct-to-definitive drug test is ordered if the drug of interest falls under the categories of larger drug classes such as benzodiazepines. If the physician needs the concentration of any drug, in particular, a direct-to-definitive drug test is an ideal solution.

This will assist the physician with a better treatment plan. If a patient’s self-declaration or past medical history denotes the drug class, then these presumptive drug tests are no more required, as they may produce false negatives colliding with the patient’s reports. 

Domain and techniques of drug screening:

Drug screening is performed for various reasons. For example, drug screening enables the employer to frame disciplinary actions at the workplace. In sports, drug screening helps to find the usage of prohibited drugs.

In a clinical setup, drug screening helps a physician discover the misuse of prescribed or non-prescribed medications. Presumptive tests are qualitative and performed with immunoassay techniques.

Definitive tests employ techniques such as chromatography and spectrometry. For all types of drug screening, blood or urine samples are commonly used. 

S2BI is one of the various tools that assist clinicians in decision-making. It helps to sort out patients into multiple levels of risk. S2BI stands for Screening to Brief Intervention. It is a set of questions used to assess patients’ detailed reports on substance or alcohol use. 

cpt code 80307

80307 CPT Code Billing Guidelines

The provider must follow reporting guidelines while using the 80307 CPT code. The following list reminds a few points a physician must keep in mind before coding CPT code 80307. 

Specific to the date of service:

The Presumptive/Definitive drug class screening procedures are specific to the day of service. That means only one presumptive and one definitive test can be billed for a patient. In addition, in any case of multiple tests on the same day, only the first Presumptive and the first Definitive tests can be billed. 

This billing guideline is suitable even if more than one providers request more than one screening on the same day. In any case, only the first presumptive and the first definitive screening are billed per patient. 

Proof of the need for drug screening:

If a physician orders a Definitive drug screening following a presumptive drug screening, the report should support the need for the latter. As Definitive screening is frequently used to identify a drug within a drug class and measure its concentration, the reason for ordering the same should be well documented.

When a patient could proclaim the substance of intake and its dosage, a Definitive drug screen can be re-considered.

Limiting the frequency of screening tests:

The frequency of testing for drugs must not exceed its necessity. This means that a provider must rightly produce documents supporting the need for repetitive tests based on the patient’s clinical condition. 

Patients possessing a low risk for drug abuse may be tested every six months. Patients identified with factors leading to moderate risk for drug abuse may be tested every three months. Patients who are often diagnosed with drug abuse may be tested every month.

This may be performed parallel with the rehabilitation therapy prescribed for patients with suspected or diagnosed drug abuse with varying risk factors. Providers are expected to avoid unnecessary drug screenings.

Finding the right drug to screen:

Reliable data can be derived from the patient’s medical history regarding a particular drug that the patient ingested. Likewise, prescribed medications for any other conditions can be underlined from the patient’s past medical history and chosen for screening.

Other documentations:

The report must contain the patient’s medical history, physical examination, previous prescriptions, and date of service with the signature. 

80307 CPT Code Modifiers

A group of CPT codes 80305–80307, G0480–G0483, and G0659 are used for testing for drugs of abuse. In addition, CPT codes from 80305 to 80307 are used to code presumptive drug tests. 

CPT codes from G0480 to G0483 and G0659 denote definitive drug tests. The CPT code G0659 exclusively stands for a Simple Definitive drug test. 

In general, Modifier 91 can be appended with a code for repeated service. As the definition and guideline for the 80307 CPT code clearly explain the specificity of the Date of Service, appending modifier 91 may not have any effect. Only one test is considered if testing is repeated on the same day. 

80307 CPT Code Reimbursement

The 80307 CPT code is applicable when the provider requests drug class screening under the following clinical conditions-

  • History of continuous substance abuse and dependence
  • Sudden changes in mental behavior
  • Alcohol dependence
  • Unconsciousness or sudden stage of coma
  • Sudden seizures unsupported by medical or family history
  • Toxic conditions
  • Any drug overdose

A group of CPT codes 80305-80307, G0480–G0483, and code G0659 are used to claim for Drug Class Screening Procedures. 

The cost for 80307 CPT code is $62.14 when testing for certain classes of drugs such as Marijuana, Cocaine, Methadone, Fentanyl, Amphetamines, Methamphetamine, Opioids, Barbiturates, etc. This applies exclusively to presumptive drug class screening.

For 1-7 drug classes, the definitive drug screening test is coded as G0480 at $114.43. The following 8-14 drug classes are coded under G0481 for a definitive drug test at $156.59.

For 15-21 drug classes, the definitive drug screening test is coded as G0482 at the cost of $198.74. The last 22+ drug classes are coded under G0483 for a definitive drug test at the cost of $246.92.

80307 CPT Code Examples

The following are examples of when 80307 CPT code may be used.

Example 1

A 52-year-old female is brought to the physician’s clinic assisted by her husband. The patient is reported to have altered mental condition after taking repeated doses of over-the-counter drugs for migraine. Physical examination showed a lower heart rate. 

The patient is reported to have taken the pain killers without medical advice and suffered a brief period of memory loss and inappropriate behavior. The physician orders a presumptive drug screening for barbiturates. The CPT code 80307 is considered appropriate. 

Example 2

A 60-year-old male visits the physician and complains of several side effects possibly due to the overdose of fentanyl drugs. After analyzing the medical history, it is evident that the patient was diagnosed with osteosarcoma one year ago. His vital signs were normal.

Following other types of chemotherapy, fentanyl drug was prescribed to relieve severe pain. Possible overdose might have led to nausea and gastro-intestinal troubles. The patient complains of a lack of appetite and other gastric disturbances after taking a high dose of fentanyl following an episode of back pain.

The physician orders presumptive drug screening to test for fentanyl compound. After obtaining rapid results for confirmation, the physician plans to proceed further. CPT code 80307 is reported.  

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