Drug Testing - (0513)

Cigna covers presumptive testing (CPT 80305–80307) and definitive testing only with HCPCS G0480 or G0659 as medically necessary (one test per date of service) when there is suspicion of drug misuse and results will guide treatment; definitive codes G0481–G0483, hair analysis (P2031), specimen verification as a separate charge, and tests billed by entities that did not perform the service are excluded. Clinical documentation must identify the specific drug(s)/substances of interest, state the clinical rationale and how results will affect the treatment plan, and providers must bill the most appropriate code with no more than one test per date of service.

"Presumptive drug testing not to exceed one test per date of service is considered medically necessary when there is a suspicion of drug misuse by the individual being tested."

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