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

Coverage for controlled substance monitoring and drugs-of-abuse testing is determined by the reasonable and necessary criteria in LCD L36393 and applies when tests are individually ordered by the treating clinician. Providers must not bill Medicare for services that the LCD does not cover (use appropriate modifier when billing non-covered services) and must maintain complete, legible medical records that support the ICD-10-CM and CPT/HCPCS codes reported.

"Controlled substance monitoring and drugs-of-abuse testing are covered when individually ordered by the treating clinician and meet the reasonable and necessary requirements specified in LCD L36393."

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