Does G0659 require prior authorization?

No, G0659 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0659?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Verity

`G0659` — Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem), excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes

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

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.

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

A56915 — Billing and Coding: Urine Drug Testing

J05

L34645 — Urine Drug Testing

J05

A59416 — Billing and Coding: Urine Drug Testing

J06

L39611 — Urine Drug Testing

J06

A57077 — Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing

J09

L36393 — Controlled Substance Monitoring and Drugs of Abuse Testing

J09

L35006 — Controlled Substance Monitoring and Drugs of Abuse Testing

J12

A56645 — Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing

J12

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

REGENCE-LAB68 — Drug Testing for Substance Use and Pain Management

REGENCE-LAB68a — Drug Testing for Substance Use and Pain Management

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

ANTHEM-CG-LAB-09 — CG-LAB-09 Drug Testing or Screening in the Context of Substance Use Disorder and Chronic Pain

A54799 — Billing and Coding: Urine Drug Testing

A55001 — Billing and Coding: Urine Drug Testing

A56818 — Billing and Coding: Urine Drug Testing

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

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