Blue Cross makes changes to its drug testing policy on urine, oral fluids, hair

Approximately one-third of chronic pain patients don’t use opioids as prescribed or they abuse them, according to the American Society of Interventional Pain Physicians.

Sometimes this misuse can be categorized as substance use disorder. The medical community defines substance use disorder as the recurrent use of alcohol or drugs that causes clinically and functionally significant physical or mental impairment, disability, and failure to meet major responsibilities at work, school or home. Doctors diagnose substance use disorder when there is drug use combined with impaired control, social impairment and risky behavior.

One strategy for monitoring substance use disorder in patients is biologic specimen testing for the presence or absence of drugs. Currently, urine is the most commonly used biologic substance.

On May 1, 2019, Blue Cross Blue Shield of Michigan changed the reporting policy for definitive drug testing. A definitive drug test is one that’s medically necessary and clinically justified when the results of presumptive testing have been evaluated and support the need for follow-up definitive testing that will contribute to clinical decision making.

Procedure codes

• Procedure codes G0480 through G0483 and G0659 should now be used for billing definitive drug testing.
• Procedure codes *80320 through *80377 and *83992 are now considered informational and should continue to be billed in addition to the appropriate G-code for reporting purposes, effective Aug. 1, 2019.

Following are additional details related to the policy change:

Inclusions

• Presumptive urine drug testing
• For outpatient pain management, presumptive urine drug testing is used in:
• Baseline screening at the initiation of treatment
• Subsequent monitoring of treatment at an appropriate frequency, based on the risk level of the individual, including assessment of aberrant behavior
• For outpatient substance use disorder treatment, presumptive urine drug testing used in:
• Baseline screening at the initiation of treatment, one time per program entry
• Weekly screening during the first four weeks of treatment
• Subsequent targeted screening once every one to three months
• For an individual not participating in outpatient pain management or outpatient substance use disorder treatment:
• When a clinical evaluation suggests use of non-prescribed medications or illegal substances
• Definitive and confirmatory urine drug testing
• Definitive urine drug testing is used:
• When immunoassays for the relevant drug or drugs aren’t commercially available
• When definitive drug levels are required for clinical decision making

Exclusions:

• Urine drug testing as a third-party requirement (for example, for employment, licensing or a court order)
• Simultaneously testing for the same drug with both a blood and a urine specimen

Note: Oral fluid drug testing and hair drug testing are considered experimental.