Presumptive and Definitive Drug Testing

Date Issued: 5/3/2019

EmblemHealth has been implementing payment policies that reflect guidelines set forth by industry authorities. Our goal is to process claims consistently and in accordance with best practice standards.

EmblemHealth has instituted additional payment policies for Presumptive* and Definitive Drug Testing.

According to the National Correct Coding Initiative Policy Manual and CMS policy, presumptive drug testing may be reported with CPT codes 80305-80307. These codes differ based on the level of complexity of the testing methodology. Only one code from this code range may be reported per date of service.

* Presumptive: Drug tests that indicate possible, but not definitive, presence of drugs and/or drug metabolites.