BCBS of IA/Wellmark of IA
The frequency of drug testing should be individualized to the treatment plan. Frequency shall not exceed every 7 days at any time during the treatment process.
Caresource of Ohio
Presumptive and Definitive Drug Testing
CareSource will reimburse for up to 5 presumptive/confirmatory tests in a quarter for each member.
In outpatient pain management, and outpatient substance abuse
Cigna
Presumptive Drug Testing
Presumptive drug testing not to exceed one 1 unit per date of service up to 32 units per year as medically necessary.
settings qualitative/presumptive (ie, immunoassay) urine drug testing may be considered medically necessary for: Baseline screening before initiating treatment or at the time treatment is initiated, one time per program entry stabilization phase - targeted weekly qualitative screening for a maximum of four weeks maintenance phase – targeted qualitative screening once every one to three months quantitative/ definitive (ie, confirmatory) urine drug testing may be considered medically necessary under the following circumstances: When immunoassays for the relevant drug(s) are not commercially available Only in specific situations for which definitive/quantitative drug levels are required for clinical decision making. Urine drug testing for patients receiving pain medication are considered medically necessary under the following conditions: • Twice a year for patients who are low or moderate risk • Four times a year for patients who are high risk At the time of the office visit for patients demonstrating aberrant behavior defined by one or more of the following: • Lost prescriptions • Requests for early refills • Obtained opioids from multiple providers • Unauthorized dose escalation • Apparent intoxication.
Definitive Drug Testing
Definitive drug testing not to exceed 16 dates of service per year for a maximum of 8 units (a unit may include a specific individual drug and/or its metabolite(s), or its structural isomer(s)) per date of service up to 128 units per year as medically necessary. Qualitative drug screen when billed with any combination of more than twenty (20) units within 365 days per Member.
Fallon Health
Presumptive Drug Testing
Humana (All Plans)
Definitive Drug Testing # HCS- 0532-015
Coverage of drug testing is limited to seven or fewer drug classes per day. G0481 and up is not covered.
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For questions call billing customer service at 844.345.1821 or email patient.billing @ DRUGSCAN.com
For questions call billing customer service at 844.345.1821 or email patient.billing @ DRUGSCAN.com
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