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Reimbursement Policy Update: Urine Drug Screening/Testing

Effective April 27, 2021, we will change how we consider and reimburse certain professional claims for urine drug screening or testing based on our revised reimbursement policy guidelines, Urine Drug Screening/Testing.

Claims for services provided on and after April 27, 2021 will be processed based on our revised policy guidelines, including the following.

  • Urine drug testing must be ordered by a licensed practitioner, such as a physician or an advanced practitioner (Physician Assistant or Nurse Practitioner), directly involved in care management of the member. Only testing ordered by these providers will be eligible for reimbursement.

  • Urine drug testing should be ordered on an individualized basis in accordance with the member’s specific needs. Generic standing orders or reflex testing that are applied in all cases to all members will not be considered for reimbursement.

  • One unit of presumptive testing (CPT® Codes 80305, 80306 or 80307) and one unit of definitive testing (limited to HCPCS code G0480 or G0659), will be considered for reimbursement when performed on the same date of service.

  • HCPCS codes G0481, G0482, and G0483 will not be considered for reimbursement.

  • We reserve the right to request documentation of the need for the amount of testing ordered. Additional documentation is required for testing of more than 24 units during a treatment year, regardless of the type of testing.

We encourage you to review our Urine Drug Screening/Testing reimbursement policy for more information.

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

Published on: January 26, 2021, 10:58 a.m. ET
Last updated on: April 22, 2021, 05:33 a.m. ET