Controlled Substance Monitoring and Drugs of Abuse Testing

Medicare covers urine (and oral fluid where appropriate) presumptive UDT for immediate clinical decision-making and definitive confirmation testing (GC‑MS or LC‑MS/MS) when specific identification or concentrations are required, for symptomatic toxicity, substance use disorder diagnosis/monitoring, and chronic opioid therapy baseline and monitoring. Testing must be individualized and documented (history, exam, meds, risk assessment, rationale), only one presumptive test is payable per patient per date of service, blanket/standing orders and many non‑clinical uses (employment/medico‑legal) are not covered, and IA methods are not acceptable as confirmatory tests. Frequency of ongoing testing must be supported by documented risk assessment and detailed utilization limits are referenced in the Utilization Guidelines.

"Presumptive (qualitative) urine drug testing (UDT) is covered when medically necessary to determine presence or absence of drugs or drug classes and when immediate results are needed (point-of-care..."