Independence has updated the coverage limits on dates of service and the list of appropriate procedure codes for drug screening/testing in our policies on presumptive and definitive drug testing in substance abuse and pain management treatments. The following policies were posted as Notifications 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 the applicable 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

Independence will cover the following appropriate procedure codes for drug screening/testing when the criteria defined in the applicable policy are met:

• CPT^® drug screening codes for presumptive drug testing for substance abuse and pain management treatments:
• – 80305
• – 80306
• – 80307

• 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, Independence 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 Notifications for these policies, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select Commercial or Medicare Advantage under Active Notifications.

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