G6053, Methadone
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Presumptiveurine drug testing (UDT) to verify compliance with treatment, identify undisclosed drug use or abuse, or evaluate aberrant* behavior, is consideredmedically necessary, beginning at the start of treatment, as part of a monitoring program tailored to the unique needs of individuals who are:
- Receiving treatment for chronic pain with prescription opioid or other potentially abused medications;or
- Undergoing treatment for, or monitoring for relapse of, opioid or other substance use disorder.
- Presumptiveurine drug testing is also consideredmedically necessaryfor the following:
- To assess an individual when clinical evaluation suggests use of non-prescribed medications or illegal substances;or
- On initial entrance into a pain management program or substance use disorder recovery program.
1 Active Policy
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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