G0659, Drug test(s), definitive, utilizing drug identification methods able to
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Documentation Required
- For services that require a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
- The claim must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the urine drug test was performed.
- For diagnostic urine drug tests, report the test result if known; if the result is not known, report the symptoms that prompted the performance of the test.
- This billing and coding guidance complements Local Coverage Determination L35724 and providers should follow LCD L35724 in conjunction with NCCI/OPPS rules when preparing claims.
- For services requiring a referring or ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
- A claim submitted without a valid ICD-10-CM diagnosis code will be returned as an incomplete claim under Section 1833(e) of the Social Security Act.
Key Coverage Criteria
- Urine drug testing (UDT) and drugs-of-abuse testing are covered when reasonable and necessary per LCD L35006 and ordered on an individual patient basis by the treating clinician with medical-record documentation of medical necessity.
- Patients with a documented diagnosis consistent with substance use disorder (SUD) may qualify for an exception to the standard presumptive UDT annual limits.
- Drug testing services are covered when they meet the medical necessity and coverage indications specified in LCD L36029.
- Medicare Part B will pay for drug screening services when furnished in allowed places of service: office (11), urgent care (20), independent clinic (49), FQHC freestanding (50), RHC freestanding (72), and independent laboratory (81).
- Urine, blood, or oral fluid specimens may be used for drug testing, with urine preferred for broad screening of common drugs.
- Medicare Part B will pay for drug screening services when all coverage criteria, limitations, and medical necessity requirements of LCD DL34645 are met.
20 Active Policies
CGS-L36029, Urine Drug Testing
J15
A56915, Billing and Coding: Urine Drug Testing
J5
A59416, Billing and Coding: Urine Drug Testing
J6
WPS-L34645, Urine Drug Testing
J8
FIRST_COAST-L36393, Controlled Substance Monitoring and Drugs of Abuse Testing
J9
A57077, Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
J9
NORIDIAN-L36668, Urine Drug Testing
JF
NOVITAS-L35006, Controlled Substance Monitoring and Drugs of Abuse Testing
JH
PALMETTO-JJ-L35724, Urine Drug Testing
JJ
NGS-L39611, Urine Drug Testing
JK
A56645, Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
JL
PALMETTO-JM-L35724, Urine Drug Testing
JM
BCBSMT-MED207.154, Drug Testing in Pain Management and Substance Use Disorder Treatment
A54799, Billing and Coding: Urine Drug Testing
A55001, Billing and Coding: Urine Drug Testing
A56818, Billing and Coding: Urine Drug Testing
AMBETTER-CP.MP.50, Drugs of Abuse: Definitive Drug Testing
MED207.154, Drug Testing (e.g. Pain Management and Substance Use Disorder Monitoring) and Screening
BCBSIL-MED207.154, Drug Testing in Pain Management and Substance Use Disorder Treatment
ANTHEM-CG-LAB-09, CG-LAB-09 Drug Testing or Screening in the Context of Substance Use Disorder and Chronic Pain
Related Codes
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