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, Maryland pain management providers must bill toxicology testing codes directly to HealthChoice MCOs instead of the behavioral health services organization. This eliminates split billing and consolidates payment responsibility with managed care organizations for these specific drug testing procedures.
Action Required
By January 1, 2025: Billing team must redirect all toxicology testing claims (CPT 80305, 80306, 80307, G0480, G0481) from BHASO to participant's HealthChoice MCO for pain management services. Update billing system routing rules and staff workflows. Pain management providers must also update their enrollment to add pain management specialty via the ePREP system at https://health.maryland.gov/mmcp/provider/Pages/eprepforms.aspx. Note: Substance use disorder treatment providers should continue billing BHASO for drug testing related to office visits.