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

Medicare covers controlled substance monitoring and drugs-of-abuse testing when reasonable and necessary per LCD L35006 and when documented in the patient's medical record. Frequency limits include up to 12 presumptive UDTs per calendar year (exception for documented SUD), no more than 3 presumptive tests in any 7-day period when billed with ICD-10 Group 1, up to 12 definitive UDTs per year for chronic opioid therapy (ICD-10 Group 2), and only one presumptive result reported per patient per date of service; all services require supporting documentation and appropriate coding.

"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..."

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