Criteria for urine drug testing (UDT)

Effective Sept. 1, 2014, Highmark Delaware may consider Urine Drug Testing to be medically necessary based on position statements of the professional organizations (i.e., American Society of Interventional Pain Physicians (ASIPP), current peer-reviewed literature and the position of other insurers). Codes 80100, 80101, 80102, 80103, and 80104 will no longer be reimbursed because these codes are not specific enough to establish appropriate justification for reimbursement for qualitative drug testing.

Reimbursement will be made for the following appropriate HCPCS qualitative drug screening codes:

• G0431—Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter)  (*1 unit per encounter; 4 per calendar year)

• G0434—Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter) (*1 unit per encounter; 12 per calendar year)

*Regardless of the number of drug classes tested, codes G0431and G0434 will deny when billed with ≥ 2 units per date of service.

Source: https://www.highmark.com/health/highmarkdelaware/pdfs/pubs/de-sb-med-policy-updates-063014.pdf