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Newsletter Vol. 31, No.11
Act
by Apr 1, 2021
Effective date
Apr 1, 2021
Identified
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare has revised drug screening and testing billing procedures effective April 1, 2021. Multiple presumptive drug testing codes (G0434, 80102, 80104) are terminated, while new HF-modifier codes are created for SUD outpatient treatment providers only. Definitive testing now requires a prior presumptive test within 7 days, limits reflex testing to specific clinical scenarios, and restricts billing frequency. Specimen validity testing codes (84311, 83986, 82570, 83789, 84315) are no longer separately billable when used with drug screening codes.
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What to do
by Apr 1, 2021 · 11 steps
01Billing team must update billing software to TERMINATE codes G0434, G0434 HF, G0434 QW, G0481, G0482, G0483, 80102, 80102 HF, 80104, 80104 HF, 80104 QW—all claims using these codes will be denied.
02For SUD outpatient treatment providers only: Configure system to allow billing of new HF-modifier codes (G0480 HF, 80305 HF, 80306 HF, 80307 HF) in place of terminated codes.
03Implement system logic to enforce billing restrictions: presumptive drug testing limited to ONE encounter per date of service and maximum TEN encounters per rolling 30 days; definitive testing limited to ONE-SEVEN drug classes per date of service and maximum TWO encounters per rolling 30 days.
04Configure automatic denial rule: definitive drug test claims (G0480, G0480 HF) must have evidence of a paid presumptive test claim on same date of service or within 7 days prior—deny all definitive claims without this documentation.
05Billing staff must stop billing specimen validity testing codes (84311, 83986, 82570, 83789, 84315) separately when billed with presumptive or definitive drug test codes on same service date; update encounter form templates.
06Providers must be notified that definitive testing should NOT be routine reflex to positive presumptive tests—only allowed for: patient disputes results, detecting specific substance unavailable via presumptive method, substances not adequately identified by presumptive methods (e.g., heroin vs. opiates), or results informing major clinical/non-clinical decisions (treatment changes, medication changes, legal status changes).
07Stop accepting 'blanket orders' for laboratory testing; establish compliance check requiring all test orders be based on patient-specific conditions per evidence-based clinical guidelines.
08Standing orders are permitted only if tied to predetermined events and patient-specific conditions.
09Failure to implement these changes will result in claim denials and post-payment audit findings.
10Providers: Update clinical protocols and order forms.
11Billing team: Update system configuration and claim denial logic.
Codes mentioned
G0434G0480G0481G0482G048380102801048030580306803078431183986825708378984315
Original notice
Newsletter Vol. 31, No.11
njmmis.com · Always check the source before changing claims.
Related changes
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