Effective August 1, 2017, our policies on presumptive and
definitive drug testing in substance abuse and pain management treatments will
be updated. Key changes are detailed below.
Specimen validity/adulteration testing
Most basic urine immunoassays have specimen validity checks built into the
screening process and allow for a basic determination of potential urine sample
tampering (e.g., dilution, substituted specimen, etc.). Most pain management
laboratories have specimen validity testing protocols; however, these are
deemed quality control measures. Specimen validity/adulteration testing is
not eligible for separate reimbursement when performed in
conjunction with presumptive and definitive drug testing, as this is considered
part of the laboratory quality control practices.
The following CPT
® procedure codes, which represent specimen
validity/adulteration testing, are being added to the policies and will not be
separately reimbursed on or after August 1, 2017:
- 82542: Column chromatography,
includes mass spectrometry, if performed (e.g., HPLC, LC, LC/MS, LC/MS-MS, GC,
GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified,
qualitative or quantitative, each specimen
- 82570: Creatinine; other
source
- 83986: pH; body fluid, not
otherwise specified
- 84311: Spectrophotometry,
analyte not elsewhere specified
- 84315: Specific gravity (except
urine)
Hair and oral drug testing
For pain management and substance abuse treatments, hair drug testing and
oral fluid drug testing are considered
experimental/investigational and, therefore, not covered because their
safety and/or effectiveness cannot be established by review of the available
published peer-reviewed literature.
Additional codes
The following codes will be added to the list of Definitive Drug Class
Testing codes as outlined within the Coding section of the policies:
- 80323: Alkaloids, not
otherwise specified
- 80327: Anabolic steroids; 1 or
2
- 80328: Anabolic steroids; 3 or
more
- 80329: Analgesics, non-opioid;
1 or2
- 80330: Analgesics, non-opioid;
3-5
- 80331: Analgesics, non-opioid;
6 or more
- 80368: Sedative hypnotics
(non-benzodiazepines)
- 80369: Skeletal muscle
relaxants; 1 or 2
- 80370: Skeletal muscle
relaxants; 3 or more
- 80372: Tapentadol
- 80373: Tramadol
Note: The codes above are included in the coverage limit of up to a
maximum of 120
presumptive and/or definitive drug tests in a calendar year when the policy
criteria are met.
For more information, please refer to the following policies, which are
currently posted as Notifications and will go into effect August 1,
2017.
- Commercial: #06.02.44c:
Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management
Treatments
- Medicare Advantage: #MA06.025c:
Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management
Treatments
To view Notifications for these policies, visit our Medical Policy Portal and select Accept and Go to
Medical Policy Online. Then select either Commercial or
Medicare Advantage under Active Notifications.
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