2025 HCPCS code G0481
(Active) Effective Date: N/A Revision Date: N/A Laboratory Services - Definitive Drug Testing Other Services Feed
Definitive drug testing for 8-14 drug classes, including validity testing, using methods like GC/MS or LC/MS.
Modifiers may apply depending on the circumstances of service, such as the location of service or the type of testing.Consult the appropriate payer's guidelines for specific modifier applications.
Medical necessity is established by a physician's order based on clinical suspicion of drug use, monitoring of therapeutic drug levels, pre-employment screening, or legal requirements (e.g., DUI).
Clinical laboratory personnel perform the testing, interpretation, and reporting of results.Physicians order the test based on clinical indications.
In simple words: This lab test checks for 8 to 14 types of drugs and their byproducts in a blood or urine sample.It uses advanced methods to accurately measure the amount of each drug found.
This HCPCS code, G0481, represents definitive drug testing encompassing 8 to 14 drug classes, including metabolites when applicable.The testing utilizes drug identification methods capable of distinguishing between structural isomers, employing 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 process incorporates stable isotope or universally recognized internal standards for quality control, along with method or drug-specific calibration and matrix-matched quality control materials.Specimen validity testing is included.This code covers qualitative or quantitative testing and reports results from all sources, for a single day's testing.
Example 1: A patient presents with symptoms suggesting opioid overdose.A comprehensive drug screen (G0481) is ordered to identify the specific opioid and other potential substances involved in the overdose., A patient is undergoing a routine pre-employment drug screening.The employer mandates a broad drug screen (G0481) covering various drug classes to ensure workplace safety., A patient is suspected of driving under the influence (DUI).A forensic toxicology test (G0481) is ordered to detect the presence of alcohol or other impairing substances.
Complete patient demographics, test order from a physician, detailed results of the drug screen including the specific substances and quantities detected, and date and time of the testing.
** The selection of a specific code (G0480-G0483) depends on the number of drug classes tested.Always verify with the specific payer for their requirements and any potential prior authorization needs.
- Payment Status: Active
- Modifier TC rule: Not applicable to this code.
- Specialties:Toxicology, Clinical Chemistry, Emergency Medicine, Occupational Medicine, Forensic Medicine
- Place of Service:Office, Hospital, Laboratory, Urgent Care Facility, Other Place of Service