MedicaidReimbursementHigh impact
Updated Definitive Drug Testing Changes
Maryland Medicaid·MD · Psychiatry, Pain Management, Infectious Disease +1 more·Behavioral Health Administration Services Organization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Maryland Medicaid updated definitive drug testing reimbursement rates and code structure effective January 1, 2025. Four HCPCS codes (G0480-G0483) now tier reimbursement by daily drug class count (1-7, 8-14, 15-21, 22+ classes), with rates ranging from $90.97 to $124.49 per test. Labs must verify medical necessity per ASAM guidelines, and pain management clinics must confirm coverage directly with MCOs.
Action Required
By December 31, 2024: Billing team must update fee schedules in billing system to reflect new G0480-G0483 rates ($90.97 for G0480; $124.49 for G0481, G0482, G0483). Implement logic to correctly tier codes based on daily drug class count (1-7, 8-14, 15-21, 22+). Laboratories must verify medical necessity documentation on all claims per ASAM guidelines before submission. Pain management clinics must contact their assigned MCOs to confirm definitive drug testing coverage under PT 47-25 before January 1, 2025. Update claim submission templates and provider education materials. Failure to apply correct tiered codes or verify medical necessity will result in claim denials or recoupments.