National Urine Drug Test Policy Changes

December 22, 2022

It seems that several MACs (Medicare Administrative Contractors) have teamed up to introduce changes to several high volume urine drug tests (UDT) that could greatly affect your practice. 

Stemming from a June 2021 audit report from the OIG calling on CMS to take action to curb the high utilization of urine drug testing, Palmetto GBA, CGS Administrators and WPS have all released proposed policies that are poised to change UDT billing.  The MACs also indicate on their proposed LCDs that the “policy is being revised as part of a collaborative process for consistency and clarity of coverage across all MAC regions.” This appears to indicate a national policy is in the works. 

The MACs plan to cut the following definitive tests which include tests performed in physician office labs. 

G0482 – 15-21 drugs classes
G0483 – 22 or more drug classes
G0659 – any number of drug classes

If these changes are implemented, practices that are performing these tests will be required to have analyzers that meet the requirements in HCPCS® codes G0480 and G0481. Additionally, providers will not be able to order labs that test more than 14 drug classes from an independent laboratory. 

It will be important for providers to review and compare the proposed LCD with their current MAC’s LCD and review proposed changes such as:
•    Definitions of key terms in the LCD, companion billing and coding article
•    A list of parent drugs and common metabolites that appear to be developed by the MACs themselves
•    Use and limits of three types of urine drug screening: presumptive, presumptive immunoassay, and definitive
•    Requirements for drug testing panels
•    Three coverage indications for UDS, and
•    An opioid risk tool

Below is each MACs proposed LCD.
CGS Administrators - DL36029
Palmetto GBA - DL35724
WPS - DL34645

Each LCD contains additional information on companion billing and the coding article. Although the comment period has expired, there is also an email address for comments. 

Be sure you are included on your MACs mailing list so you can remain up-to-date on these policies as changes and updates occur.


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