Coding updates for Medical Policies

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Coding updates for Medical Policies

Date Issued: 03/18/2020

Please note that coding and coverage criteria for the following medical policy has been updated. The clinical criteria for this policy hasn’t changed.

Urine Drug/Alcohol Testing — Added the following reimbursement rules to Limitations/Exclusions Section denoting July 1, 2020 effective date.

  • Presumptive and Definitive drug testing not to exceed one (1) unit per date of service up to 18 units per year (12 months), submitted by the same or different provider.
  • CPT codes 80320-80374 Drug test(s), individual types (Not reimbursed).
  • Specimen validity testing, including, but not limited to, pH, specific gravity, oxidants and/or creatinine is not covered. EmblemHealth will deny Specimen Validity Testing when performed by the same or different provider.
  • CPT codes 80375-80377 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified (Not reimbursed)
  • Confirmation testing when there hasn’t been an initial screen or confirmation testing conducted for drug classes other than the one(s) in question. For this reason, G0482-G0483 are considered not covered. G0481 must be appealed with documentation to support medical necessity.