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.

• 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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