Urine Drug Testing

Medicare covers presumptive (qualitative) UDT when medically necessary for immediate clinical decision-making and covers definitive (GC‑MS or LC‑MS/MS) UDT when clinically indicated to identify specific drugs or metabolites. Testing must be individualized and documented in the medical record (history, exam, treatment plan, prescribed medications, risk assessment, and clinician rationale), and testing frequency is limited by specified rolling-period maxima for SUD and risk-stratified COT patients; specimen validity QA testing is not separately payable.

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

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