In order to effectively treat chronic pain, physicians rely on drug testing to monitor prescribed medications and drugs of abuse. Urine Drug Screening tests which provide qualitative or semi-quantitative initial screen or preliminary results may not be reported with a quantitative code, i.e., codes in the Therapeutic Drug Assay or Chemistry Sections of the CPT book.
Initial screening tests may be performed and billed at point of care or at independent / hospital laboratories, but not both. A second screening of the same urine specimen is considered medically unnecessary. It is the responsibility of the ordering physician to coordinate billing of initial screening tests.
Additionally, quantification of all drugs tested for in a urine drug panel, without regard to screening results, is considered medically unnecessary. Confirmation/quantification of any drug should be the result of an initial positive screen for a drug class, or where there is a documented medical necessity in the patient record for the identification/quantification of a specific drug.
The following paragraphs were added to provide clarity to the policy on urine drug testing:
Physicians Manual: Section 13.41.E
Qualitative and semi-quantitative drug screening tests are covered by the MO HealthNet Program. Refer to the CPT book for appropriate procedure codes to reflect testing on single or multiple drug classes. A drug screen test reports what drug classes (e.g., tricyclic antidepressants, phenothiazines, amphetamines, benzodiazepines, barbiturates, cannabinoids, methadone, opiates) are present (qualitative) and may provide an estimate (semi-quantitative) of the concentration. An initial drug screen or preliminary test that yields qualitative or semi-quantitative results must be reported with an appropriate drug testing procedure code categorized as such in the CPT book. Codes in the Therapeutic Drug Assay or Chemistry Sections of the CPT book may not be used to report qualitative or semi-quantitative drug screening and preliminary test results. Physician offices may bill for initial drug screens performed at point of care (e.g., by use of CLIA waived test devices) or independent and/or hospital laboratories may bill for screenings they performed, but both cannot be billed. It shall be the responsibility of the ordering physician to coordinate with the performing laboratory for the billing of drug screen tests.
Providers should not routinely bill for the quantification of drug classes. Providers should only bill for the quantification of a drug class or a confirmatory drug test (i.e., billing procedure codes from the Therapeutic Drug Assay or Chemistry sections of the CPT book) if there is a positive screen for the drug class to be quantified.