Urine Drug Testing

Medicare covers medically necessary presumptive (IA) and definitive (GC‑MS/LC‑MS/MS) urine drug testing — including POCT at the point of care — with risk‑based frequency caps (moderate risk: up to 2 presumptive and 2 definitive per rolling 180 days; high risk: up to 3 presumptive and 3 definitive per rolling 90 days) and excludes routine/blanket orders, duplicate presumptive tests billed the same date, reference labs performing presumptive IA without a physician’s order, reflex definitive testing when POCT provides sufficient clinical information, and any tests exceeding stated limits. Coverage requires patient‑specific documentation of medical necessity (risk assessment, rationale for presumptive vs direct‑to‑definitive testing, justification for tests beyond limits, and use of results to manage care); labs reflexing must verify presumptive positives by definitive methods before reporting when done without a new clinician order, and only one presumptive test is payable per patient per date of service.