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AmeriHealth has updated the coverage limits on dates of service and the
list of appropriate procedure codes for drug screening/testing in our policy on
presumptive and definitive drug testing in substance abuse and pain management
treatments. Medical Policy #06.02.44e: Presumptive and Definitive Drug Testing
in Substance Abuse and Pain Management Treatments was posted as a Notification
on October 13, 2017, and will go into effect January 1, 2018.
Dates of service
Drug testing for any drug class by any test method and/or testing
combinations is considered medically necessary, and therefore covered, up to a
maximum of 24 dates of service in a calendar year when the criteria defined in
this policy are met. More than 24 dates of service for presumptive and/or
definitive drug tests in a calendar year will not be considered
medically necessary and, therefore, will not be covered.
Procedure codes
AmeriHealth will cover the following appropriate procedure codes for drug
screening/testing when the criteria defined in this policy are met:
- CPT® drug screening codes for presumptive drug testing for
substance abuse and pain management treatments:
- HCPCS codes for definitive drug testing for substance abuse and pain
management treatments:
- – G0480
- – G0481
- – G0482
- – G0483
- – G0659
In accordance with the Centers for Medicare & Medicaid Services guidelines,
AmeriHealth will not cover CPT codes 80320 ? 80377 and 83992 for
definitive drug testing for substance abuse and pain management treatments.
These codes will not be covered because of the potential for inappropriate
payment when billing for each individual drug test, rather than a single code,
regardless of the number of drugs being tested.
For more information
To view the Notification for this policy, visit our Medical Policy Portal. Select Accept and Go to Medical
Policy Online, and then select Commercial under Active
Notifications.
CPT Copyright 2016 American Medical Association. All
rights reserved. CPT® is a registered trademark of the American
Medical Association.
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