84311
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Referring clinician's written order that specifies each drug or drug class being tested and is recorded in the patient's medical record.
- Patient-specific clinician documentation that accurately reflects the clinical need for each test.
- Documentation of an adequate clinical assessment of patient history and risk of substance use disorder for baseline testing.
- Documentation that clinicians interpreting tests have knowledge of test interpretation.
Key Coverage Criteria
- Drug testing for monitoring patients receiving pain management
- Drug testing for monitoring and screening for substance use disorder (SUD)
- Perform drug/drug-class screening only for drugs or drug classes likely to be present based on the patient's medical history or current clinical presentation.
- Each drug or drug class to be tested must be specifically indicated in the referring clinician's written order.
- Urine is the preferred specimen matrix for drug testing.
- Alternative matrices (blood, exhaled breath, oral fluid, sweat, hair) are medically necessary when urine cannot be collected (e.g., patients on dialysis or with shy bladder) or when urine collection is too invasive.
5 Active Policies
BCBSIL-MED207.154 — Drug Testing in Pain Management and Substance Use Disorder Treatment
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
BCBSOK-MED207.154 — Drug Testing in Pain Management and Substance Use Disorder Treatment
MED207.154 — Drug Testing (e.g. Pain Management and Substance Use Disorder Monitoring) and Screening
Related Codes
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