Drug Testing (e.g. Pain Management and Substance Use Disorder Monitoring) and Screening

This policy covers drug testing and drug-class screening—preferably urine, with alternative matrices (blood, oral fluid, hair, sweat, breath) when urine is unobtainable or a different detection window/isolation from tampering is clinically required—for monitoring patients receiving pain management and for baseline, stabilization and maintenance screening/monitoring of substance use disorder. Coverage requires a clinician’s written order specifying each drug/drug class, an individualized clinical assessment and documented justification for quantitative/definitive testing (e.g., unexpected or discordant results or when immunoassays are unavailable), is subject to the member’s benefit plan, and generally limits qualitative testing to ~15 tests and quantitative testing to ~12 tests per 12‑month period unless additional medical necessity is documented.

"Drug testing for monitoring patients receiving pain management"