MedicaidAdministrativeHigh impact
Payment Responsibility for Pain Management Clinic Toxicology Testing, Effective January 1, 2025
Maryland Medicaid·MD · Pain Management·Behavioral Health Administration Services Organization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Effective January 1, 2025, pain management clinics in Maryland must now bill HealthChoice MCOs directly for toxicology/drug testing services instead of splitting billing between MCOs and the BHASO. This eliminates the previous split-billing arrangement and consolidates toxicology testing claims under MCO responsibility. The policy specifies seven covered drug testing procedure codes with minimum Fee-for-Service reimbursement rates.
Action Required
Effective immediately for claims dated January 1, 2025 and forward: (1) Billing team must update billing system configuration to route all toxicology testing claims (CPT 80305, 80306, 80307 and HCPCS G0480, G0481, G0482, G0483) to HealthChoice MCOs instead of Carelon Behavioral Health BHASO for pain management clinic encounters; (2) Remove BHASO billing rules for these drug testing codes from billing software; (3) Update claim submission logic to ensure pain management specialty providers bill MCOs at minimum Fee-for-Service rates ($10.02 for 80305/80306, $49.40 for 80307, $90.97-$124.49 for G0480-G0483); (4) Train billing staff that substance use disorder treatment providers continue billing BHASO for drug testing (this change applies only to pain management clinics); (5) Verify provider enrollment includes pain management specialty addendum updated on ePREP portal before submitting claims. Failure to route claims correctly will result in claim denials and payment delays.