0082U
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.
- Documentation of medical necessity for testing must be maintained in the patient's medical record and must conform to the documentation requirements in LCD L36393.
- Every page of the medical record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).
- The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Key Coverage Criteria
- Controlled substance monitoring and drugs-of-abuse testing are covered when individually ordered by the treating clinician and meet the reasonable and necessary requirements specified in LCD L36393.
- Presumptive (qualitative) UDT is reasonable when immediate results are needed to determine presence/absence of drug classes to guide urgent clinical decisions.
- Definitive (GC-MS or LC-MS/MS) UDT is reasonable to identify a specific substance or metabolite inadequately detected by presumptive UDT.
- Definitive UDT is reasonable to definitively identify specific drugs within a large family of drugs when specificity affects clinical management.
- Definitive UDT is reasonable to identify substances not detected by presumptive UDT (e.g., fentanyl, meperidine, synthetic cannabinoids, designer/synthetic analog drugs).
- Definitive UDT is reasonable to confirm a positive or negative presumptive UDT result that is inconsistent with patient self-report, presentation, history, or current prescribed pain medication plan.
10 Active Policies
L36393 — Controlled Substance Monitoring and Drugs of Abuse Testing
J09
A57077 — Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
J09
BCBSMT-MED207.154 — Drug Testing in Pain Management and Substance Use Disorder Treatment
BCBSNM-MED207.154 — Drug Testing in Pain Management and Substance Use Disorder Treatment
Related Codes
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