Clinical laboratories handle a substantial volume of insurance claims. This applies equally to both in-house laboratories and third-party facilities. Drug quantitative tests are frequently performed in all clinical labs. It is a significant source of revenue, and healthcare providers cannot afford to have their claims denied for these.
One of the drug quantitative test codes that is often misused is CPT code 80299. That is why we have prepared an in-depth guide on this code. So, let’s get into the details.
CPT Code 80299 – Description
CPT code 80299 is defined as:
“Quantitation of therapeutic drug, not elsewhere specified.”
Code 80299 is used in clinical laboratories. It belongs to the ‘Therapeutic Drug Assays’ section (80150-80299) of the CPT codes manual. The code refers to a procedure that calculates/quantifies the amount of drug in a patient’s blood to ensure that it is within a therapeutic range and does not lead to toxicity.
However, it serves as an unlisted code. What it means is that it is used to quantify a medicine/drug that is not specifically covered by any other CPT code.
It is important to clarify here that CPT code 80299 is used for therapeutic drug monitoring of prescribed medication only. Hence, you cannot use it for situations in which illicit drug use or substance abuse needs to be monitored.
Billers must note that although code 80299 is similar to presumptive drug testing codes (80305-80307) or definitive drug testing codes (G0480-G0483), it is fundamentally different from them. The difference between them is that the presumptive and definitive tests are performed to identify the presence or absence of drugs. On the contrary, CPT code 80299 is used to measure the exact therapeutic drug levels.
So, when filing claims, it is crucial to pay attention to details. Otherwise, a small mistake can result in denial.
Scenarios Where CPT Code 80299 is Applicable
Let’s look at a couple of real-world scenarios in which a physician might order an unspecified drug quantification test and report it via CPT code 80299.
Drug and Toxicity Level Monitoring
You can use the code when physicians need to maintain particular levels of a drug in a patient’s bloodstream. This is common in pain management medication or when a physician needs to monitor the toxicity levels.
Drug Interaction Monitoring
Another situation where physicians use 80299 is when checking how different drugs interact in a patient’s body. This is common with multiple medications, such as measuring levels of a seizure drug affected by another medicine. It helps adjust doses to ensure the drugs work safely without causing side effects.
Applicable Modifiers for CPT Code 80299
To get fair reimbursement for your services, you must append the appropriate modifiers to your claims whenever necessary. The following are some commonly used modifiers with CPT code 80299:
| Modifier | Description | Usage Guidelines |
|---|---|---|
| 59 | Distinct Procedural Service | Applied when other separately identifiable services are rendered on the same date as the therapeutic drug quantitation procedure. |
| 90 | Reference Laboratory | Applied when the therapeutic drug assay is performed by an outside reference laboratory rather than the billing provider’s facility. In the case of Medicare claims, the referred laboratory must have a specialty code 69. |
| 91 | Repeat Clinical Diagnostic Laboratory Test | Used when the same therapeutic drug level test is repeated on the same day for the same patient. |
Please use the modifiers only when necessary and medically justifiable. Inappropriate use of these modifiers will lead to claims denials.
CPT Code 80299 – Billing & Reimbursement Guidelines
CPT code 80299 might seem straightforward based on the scenarios we outlined above. However, denials can still occur if you don’t adhere to billing guidelines and pay close attention to details. Here are some essential points to remember when submitting claims for 80299.
Complete the Documentation Requirements
Since 80299 is an unlisted code, you must append comprehensive documentation with its claims. Proper documentation helps justify the medical necessity of the procedure. It also provides insurance payers with information regarding the circumstances in which the test was conducted.
For 80299 claims, ensure to provide the following details:
- Specific identification of the therapeutic drug being monitored.
- Clinical rationale for therapeutic drug monitoring.
- A concise description of the drug in Form Locator 80 on the CMS-1450 claim form (for claims being filed by institutional healthcare providers).
- A concise description of the drug in box 19 on the CMS-1500 form (for claims filed by individual healthcare providers).
- Patient’s prescription history and current medications.
- Expected therapeutic range and clinical significance of results.
- Physician order specifically requesting therapeutic drug level monitoring.
- Laboratory methodology and analytical approach used.
Check the Medicare Reimbursement Rates
Reimbursement for CPT code 80299 varies significantly based on geographic location, payer type, and contract negotiations. Medicare does not reimburse 80299 claims under the Physician Fee Schedule. It has assigned CPT 80299 the status code “X”, which makes it a statutorily excluded service.
However, CMS has included this code in the Clinical Laboratory Fee Schedule (CLFS), under which it is reimbursable. Under CLFS, code 80307 has a national reimbursement rate of $18.64.
Wrapping Up
We know this is a lot of information to take in, so let’s do a quick recap.
CPT code 80299 is an unlisted code. It is used to bill a therapeutic drug quantitative test for a drug that does not have a specific code assigned to it. To avoid denials and receive fair reimbursement, append the appropriate modifiers (when needed) and provide detailed documentation.
You can follow our guide to submit clean claims. However, if you are tired of constant denials and drowning in paperwork, you can always get professional help. Many billing companies, such as MediBillMD, offer specialized clinical lab billing services at affordable rates.
