Urine Drug Testing

Medicare covers presumptive (immediate) and definitive (GC‑MS/LC‑MS/MS) urine drug testing when medically necessary and individualized to the patient’s clinical situation, including symptomatic presentations, diagnosis/monitoring of substance use disorder, and chronic opioid therapy monitoring. Tests must be documented in the medical record with rationale, and frequency limits apply by abstinence duration for SUD and by risk category for COT; specimen validity testing is quality assurance and not separately payable. CLIA-certified laboratories and qualified personnel are required for definitive testing.

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

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