Be certain about what you do

Toxicology billing can become convoluted because it undergoes constant and seemingly random changes very frequently. CMS has repeatedly introduced new toxicology CPT codes only to later reverse or eliminate them. In many cases, toxicology labs have resorted to trial and error, hoping they choose the appropriate code for a particular level of drug testing. The drastic changes in toxicology billing in the past five years have caused a considerable decline in reimbursements. You have to be absolutely certain that you are providing the proper screening or confirmation tests, and your billing must accurately reflect the services you provided.


Its not that easy to submit
Toxicology Billing Claim

The challenges don’t end with accurate coding for tests and services, however. Successful medical billing for toxicology lab work often depends on the documentation provided by the ordering physician. Without patient-specific CPT requirement drug codes that clearly offer a diagnosis or indicate medical necessity, claims are denied. Denials are often based on a lack of medical necessity for the number of drug classes tested on one patient. And test frequency is important to consider as well. If a specific toxicology lab test has been performed more frequently than the coverage allows, your lab will not be reimbursed for your services. These service and billing issues place an unnecessary financial burden on labs.

Toxicology Billing Claim

right billing partner

Avoid difficulties by Choosing
Right Billing Partner

For most labs—particularly small and medium-sized labs that have great difficulty securing insurance contracts—it is critical to choose the right billing partner. That means staying up to date on the constant additions, deletions, and revisions to toxicology codes. It also means frequent communication with multiple physicians and facilities to be certain you have access to all of the patient data and documentation required to support the billing claim. And this needs to be done quickly – the longer you wait after the date of service to submit a claim, the more difficult it is to get reimbursed. Finally, you need aggressive, daily denial management. In many cases, a lab’s ability to provide services and remain in business depends on these billing practices.

Providing Patient Care

You should focus on
Providing Patient Care

Medcare MSO is trusted by toxicology labs nationwide. Our clients are able to focus on patient care and best practices in testing because they can rely on our team to help keep their data and documentation organized. Our certified medical billing specialists fully understand the complexities of toxicology billing to ensure the accuracy and timely filing of claims. And we don’t stop there. Our billers and coders stay on top of coding changes and reporting requirements as they happen, but we also look at potential issues that could occur in the future. We take pride in identifying, correcting, and collecting on denied claims because we understand that the future of your lab depends on the work we do today.