CPT 80101-QW Drug screening.

Hi, My provider is a pain management specialist in Arizona, we have a CLIA waiver no. and billing for Drug screening, this services is being paid by got and few commercial payers. But Cigna and few HMO e.g Mercycare, APIPA, PHP and Health-Choice are denying the services stating this is a Lab service and should be routed to a their contracted LAB. please advice what to do?

Easy answer

talk to your insurance rep and get them to pay. Just because a test is waived and can be done in the office does not mean an insurer will pay for it. I would present that this is like a strep test- the results are needed at the time of visit, not two days later. The tests DIRECTLY impact what will be done for the patient that day. If their screen is negative then they may be diverting drugs; if it shows other substances then they are in violation of their pain contract.

Preferred Lab

Here in Alabama, our Blue Cross wouldn't pay for in-office drug screens unless we became one of their preferred labs. But once we did the paperwork, getting approved was easy. I'd suggest talking to your insurers and find out if you can be designated as one of their preferred labs so you can do the drug screens in house and still get paid. Hope that helps.