Urine Drug Testing

Medicare covers presumptive urine/oral-fluid drug testing when medically necessary for immediate clinical decision-making and POCT when clinician and beneficiary are co-located. Definitive testing (GC‑MS/LC‑MS/MS) is covered when clinically indicated to identify specific drugs/metabolites not detected by presumptive assays, to confirm inconsistent results, or to guide management, provided the clinician documents medical necessity and the testing is performed within the policy frequency limits and in appropriately certified laboratories. Specimen validity testing is quality assurance and not separately payable, blanket (non-individualized) orders do not meet medical necessity requirements, and tests billed in excess of stated frequency limits are not covered.

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