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

This policy addresses drug testing in patients with substance use disorder or chronic pain, focusing on urine drug testing (presumptive and definitive). Presumptive urine drug testing is medically necessary from the start of treatment as part of an individualized, risk‑tailored monitoring program to verify adherence, detect undisclosed use/abuse, evaluate aberrant behavior, or when clinical evaluation suggests use of non‑prescribed or illicit substances. Testing is not medically necessary when these criteria are not met; definitive UDT that does not meet them, panel tests unless each analyte is individually justified, and drug testing using blood, saliva, sweat, or hair (the latter three in all cases) are not covered.

"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 s..."