Controlled Substance Monitoring and Drugs of Abuse Testing

This LCD permits presumptive (qualitative) UDT for immediate clinical decisions and permits definitive UDT (GC‑MS or LC‑MS/MS) when specificity is required (e.g., detection of fentanyl, confirmation of inconsistent results, identification within a drug family). Testing must be individualized with clinician-documented medical necessity, appropriate risk stratification, and specified frequency limits (SUD and COT thresholds detailed), and testing must be performed by CLIA‑certified, appropriately validated laboratories. Excessive testing beyond the enumerated frequency limits, blanket orders, use of unvalidated assays, or use of quantitative values to determine exact dose/timing are not reasonable or covered.

"Presumptive (qualitative) UDT is reasonable when immediate results are needed to determine presence/absence of drug classes to guide urgent clinical decisions."