WPS Medical Policy Updates

May 2018

Urine Drug/Alcohol Screening and Testing

Prior authorization is not required.

Additional required documentation:

Interim history and results of previous screening/testing and documentation of results in the context of the medical history. Include history of opioid use and the history of the medical condition associated with the indication for opioid therapy.

Presence or absence of aberrant behaviors related to chronic pain management or addiction (e.g., self-escalation of dose, doctor-shopping, indications/symptoms of illegal drug use, evidence of diversion, or other documented change in affect or behavioral pattern).

Current treatment plan, including timeline for future testing and changes in management based upon the previous result(s).

Added to Limitations of Coverage:

Routine analysis for specimen integrity is considered not medically necessary and will not be reimbursed separately.

Drug screening/testing on hair or oral fluids (saliva) is considered experimental, investigational, unproven, and not medically necessary, and may also be an exclusion of the health plan.

Routine reflex testing of positive preliminary results to confirmatory testing.

Source: https://www.wpshealth.com/resources/files/28300-1805-wps-medical-policy-updates.pdf