Drug Testing (urine/serum) Frequency Guidelines per Indication for testing – must be supported by documentation in the medical record and will require prior authorization if the testing exceeds the following limits:
Diagnosis of altered mental status:
Diagnosis of a medical condition where drug toxicity may be a contributing factor:
Behavioral Health Treatment Programs:
Definitive testing is limited to no more than seven substances per day.
Pain Management Program (Non-Behavioral Health):
Presumptive/Screening Urine Drug testing is medically necessary for the following:
Baseline screening before initial entrance into a pain management program
For patients receiving chronic opioid therapy for chronic pain, frequency of testing depending on the *patient’s risk level (using a validated opioid risk assessment tool).
Presumptive screening for compliance monitoring may be appropriate for up to 12 times per year with provision for monitoring for unexpected results, complaints or *aberrant behavior
Definitive testing should be conducted only for confirmatory purposes and should not exceed 12 units per year.Definitive testing is limited to no more than seven substances per day.
All testing during treatment must be supported by documentation in the medical record and will not exceed 12 units per year without a prior authorization.
*Aberrant behavior includes, but is not limited to, lost prescriptions, repeat requests for early refills, prescriptions from multiple providers, unauthorized dose escalation, and apparent intoxication.
These are the associated codes:
G0477 - CMS has cross walked this code to CPT code 80305 (presumptive).
G0478 - CMS has cross walked this code to CPT code 80306 (presumptive)
G0479 - CMS has cross walked this code to CPT code 80307 (presumptive)
G0480 Drug test(s), definitive
G0481 Drug test(s), definitive
G0482 Drug test(s), definitive
G0483 Drug test(s), definitive