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The Division of Workers’ Compensation has posted an adjustment to the pathology and clinical laboratory section of the Official Medical Fee Schedule to conform to the 2016 changes in the Medicare payment system, as required by Labor Code section 5307.1.

The update includes all fee schedule changes identified in Center for Medicare and Medicaid Services (CMS) Change Request (CR) number CR 9465, which can be accessed on the CMS website.

The 2016 update includes significant changes to the codes and rules related to drug testing. The Administrative Director’s order adopts the Medicare 2016 Clinical Laboratory Fee Schedule and the “Calendar Year (CY) 2016 Clinical Laboratory Fee Schedule (CLFS) Final Determinations” document. The order is effective for services rendered on or after Jan. 1, 2016 and can be found on the DWC website .

Some analysts believe the rate changes for lab testing could shave as much as 91% off the price of some tests. Current coding for testing for drugs of abuse relies on a structure of “screening” (known as “presumptive” testing) followed by “confirmation” to confirm the results of the screening tests and quantitative or “definitive” testing that identifies the specific drug and quantity in the patient. CMS was concern about the potential for overpayment when billing for each individual drug test rather than a single code that pays the same amount regardless of the number of drugs that are being tested.

Thus in 2014 CMS created alphanumeric G codes to replace the 2014 CPT codes that were deleted for 2015. In Jul y 2015, CMS proposed to delete all current drug testing G codes, and continue to not recognize the new AMA CPT codes, and create a single G code for presumptive testing and a single G code for definitive testing. After public comment the final rule creates three G codes for presumptive testing and for definitive drug testing, it will create four tiered G codes. The revised fee schedule will continue to not recognize the AMA CPT codes 80300 – 80377