Urine Drug Testing

Medicare covers presumptive (qualitative) UDT when medically necessary for immediate clinical management and covers definitive (GC‑MS or LC‑MS/MS) UDT when clinically indicated to identify specific drugs or metabolites not adequately detected by presumptive tests. Testing must be individualized, documented in the medical record (including history, exam, prior labs, treatment plan, prescribed meds, and risk assessment), and performed within specified frequency limits for SUD and chronic opioid therapy based on abstinence duration or opioid-risk stratification; specimen validity testing is quality assurance and not separately payable.

"Presumptive (qualitative) UDT is covered when medically necessary to immediately determine the presence or absence of drugs or drug classes in a urine/oral fluid sample for immediate clinical manag..."

Sign up to see full coverage criteria, indications, and limitations.