Toxicology Laboratory Billing Services

Medical billing for toxicology laboratory work is highly complex and undergoes frequent — and often unpredictable — changes. In 2015, Medicare implemented G-codes intended to simplify billing. Most insurance companies followed suit. But for 2016, Medicare revised its guidelines again, deleting all 2015 drug testing G-codes and continuing not to recognize AMA CPT codes for drug testing. Rather, Medicare created three G-codes for presumptive testing and four G-codes for definitive testing. Commercial insurance companies have not indicated if they will follow the same revised guidelines.

Further complicating matters, lab testing and overutilization is an area of focus for and scrutiny by CMS, the Office of Inspector General and the U.S. Department of Justice. To ensure labs receive appropriate reimbursement for their toxicology billing and do not draw the attention of regulators, billers must keep up with frequent changes to guidelines, both from Medicare and commercial payors, and be familiar with how to apply current rules, such as those dictating use of medically unlikely edits (MUEs) and modifiers.

Labs nationwide turn to PGM for their toxicology billing. PGM is well-versed in the nuances of toxicology billing and will work hand-in-hand with your lab to identify the appropriate billing guidelines your payors follow and overcome problem areas, such as the correct use of MUEs and modifiers. For more than 30 years, PGM’s team of certified, expert medical billers has helped ensure labs receive proper compensation for services provided.

To learn more about our toxicology laboratory billing services, request a free demo or contact us for more information.