Definitive Drug Testing (Commercial & Medicaid)

09/02/2021

Definitive drug testing, also known as confirmation testing, is used when it is necessary to identify specific medications, illicit substances, and metabolites. Definitive urine drug testing (UDT) reports the results of drugs absent or present in concentrations of ng/ml. Definitive drug testing is qualitative or quantitative to identify possible use or non-use of a drug. These tests identify specific drugs and associated metabolites.

There are four HCPCS codes that may be used. Each represents a different number of drug classes to be tested:

  • G0480: 1-7
  • G0481: 8-14
  • G0482: 15-21
  • G0483: 22 and over

For definitive drug tests, we recommend using HCPCS code G0480. Definitive drug testing for more than seven drug classes (using procedure code G0481) is only appropriate for Commercial claims in rare circumstances as listed in our reimbursement policy. Per our Commercial and Medicaid Urine Drug and Alcohol Testing policy*, HCPCS codes G0481-G0483 are not covered when definitive drug testing is done prior to an initial screen or used to identify drug classes other than the one(s) in question. Claims for G0481 may be appealed with clinical documentation.

Starting Jan. 01, 2022, our claims system is being updated to automate the limitations and exclusions section of our policy regarding HCPCS codes G0481-G0483. The system will check for the initial screening and drug classes tested. If the policy’s criteria are not met for members with Commercial and Medicaid plans, the claim will deny.

*Our policy follows practice guidelines supported by the American Society of Addiction Medicine (ASAM).