2025 HCPCS code G0480

Definitive drug testing for one to seven drug classes, including validity testing.

Follow payer-specific guidelines.Medicare requires specific documentation to support medical necessity for G0480 and related codes.For Medicare beneficiaries, this code should not be used unless testing is for more than 7 drug classes.

Modifiers may apply depending on the circumstances of the service and payer requirements (e.g., modifier 99 for multiple procedures).

Medical necessity for definitive drug testing must be documented, and must be based on patient-specific factors.Examples include monitoring treatment compliance, evaluating suspected overdose or intoxication, and confirming drug use in forensic or legal situations.

Laboratory analyst performs the test and interprets results; ordering physician uses the results for clinical decision-making.

IMPORTANT G0481-G0483 (for 8-14, 15-21, and 22+ drug classes respectively).CPT codes 80320-80377 are not used for Medicare billing; instead, use G0480-G0483.

In simple words: This lab test identifies specific drugs and their byproducts in a sample (like urine or blood). It gives exact amounts or simply a positive/negative result for one to seven types of drugs tested on one day.

This HCPCS code (G0480) represents definitive drug testing, a qualitative or quantitative laboratory procedure to identify and/or quantify specific drugs and their metabolites within one to seven drug classes.The testing methodology may include techniques such as gas chromatography/mass spectrometry (GC/MS), liquid chromatography/mass spectrometry (LC/MS) (excluding immunoassays), or enzymatic methods (e.g., alcohol dehydrogenase). The analysis includes specimen validity testing. This code is reported per day of service, and only one code from the G0480-G0483 range can be billed per day.

Example 1: A patient presents with suspected opioid overdose. A definitive drug screen (G0480) is ordered to identify the specific opioid and its concentration., Routine toxicology screening as part of a pre-employment physical for a position requiring drug-free workplace compliance., Monitoring patient compliance with prescribed medications in a substance abuse treatment program.A panel covering opiates, benzodiazepines, stimulants, and cannabinoids is ordered, and G0480 may be used if the number of classes tested falls within the range of 1-7.

* Physician's order specifying the drug classes to be tested.* Patient demographics and relevant medical history.* Detailed laboratory report including the methods used, the identified substances, and their concentrations.* Documentation of medical necessity (patient history, physical exam findings, risk assessment, treatment plan, prescribed medications).

** This code is part of a family of codes (G0480-G0483) that differ based on the number of drug classes tested.Always select the appropriate code based on the number of drug classes tested.Payers may have specific requirements for coverage, so consult payer guidelines for definitive information.Specimen collection may be billed separately using appropriate codes, depending on payer requirements.

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