Urine Drug Testing

Medicare covers presumptive urine (or oral fluid) drug testing when immediate presence/absence results are medically necessary and covers definitive UDT (GC‑MS or LC‑MS/MS) when specific identification of drugs, metabolites, or synthetic/analog substances is required and documented. Testing must be individualized and documented in the medical record (history, exam, meds, risk assessment, DSM‑5 when relevant), performed in CLIA‑compliant settings, and adhere to specified frequency limits based on abstinence duration, SUD status, or opioid risk stratification for chronic opioid therapy. Specimen validity testing is quality assurance and not separately payable, presumptive IA tests are not confirmatory, and blanket/non‑individualized profiles are not reasonable and necessary.

"Presumptive (qualitative/IA) urine drug testing is covered when medically necessary to immediately determine the presence or absence of drugs or drug classes for immediate clinical management."