Medical Policy Revision: Urine Drug Testing in Pain Management and Substance Abuse Treatment Setting

Effective August 6, 2019, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims based on revisions to our medical policy, Urine Drug Testing in Pain Management and Substance Abuse Treatment Setting.

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after August 6, 2019 to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) or Medicare Advantage (MA) plans will be processed as follows.

For services provided to patients 18 years of age or older:

• The services represented by CPT® code 0051U included on claims for patients enrolled in Horizon BCBSNJ commercial or Administrative Services Only (ASO) plans will be denied as experimental/investigational, non-covered services regardless of the submitted diagnosis code(s).


• The services represented by CPT code 0051U included on claims for patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be denied as non-covered services regardless of the submitted diagnosis code(s).

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after August 6, 2019.

¹The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.

CPT® is a registered mark of the American Medical Association.