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Private Property of Blue Cross and Blue Shield of Florida.
This medical policy (medical coverage guideline) is Copyright 2014, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2014 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

05-86000-32

Original Effective Date: 11/15/13

Reviewed: 11/05/13

Revised: 00/00/00

Subject: Qualitative Drug Screening

THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION.

Position Statement Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines
Other References Updates

Decision Tree

 

DESCRIPTION:

A qualitative drug screen reports the presence of a drug in a blood or urine specimen. Urine is usually the preferred specimen type due to its sensitivity to many common drugs compared to blood specimens. A qualitative drug screen may be appropriate for various reasons such as when the history is unreliable or for the identification of specific drugs.

Qualitative testing provides a means to screen for evidence of recent ingestion of drugs within specific drug classes. Examples of drugs or classes of drugs that are commonly assayed by qualitative tests include alcohols, amphetamines, barbiturates, benzodiazepines, cocaine and metabolites, methadone, opiates, phencyclidine, phenothiazines, propoxyphene, and tricyclic antidepressants.

POSITION STATEMENT:

Qualitative drug screening meets the definition of medical necessity for ONE of the following indications:

  1. A member presents with suspected drug overdose or suspected drug misuse AND ONE of the following:
  1. The management of a member under treatment for substance abuse when there is suspicion of continued substance abuse.
  2. The management of a member with chronic pain in which there is a significant pre-test probability of nonadherence to the prescribed drug regimen as documented in the patient’s medical record.
  3. The management of a member with chronic pain in a designated pain management clinic where this select population has a significant pretest probability of drug interactions and side effects.

Qualitative drug screening does not meet the definition of medical necessity for members who do not meet the above criteria or for the following indications:

BILLING/CODING INFORMATION:

CPT Coding:

80100

Drug screen, qualitative; multiple drug classes chromatographic method, each procedure

80101

Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

80102

Drug confirmation, each procedure

80104

Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure

HCPCS Coding:

G0431

Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter

G0434

Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter

REIMBURSEMENT INFORMATION:

Refer to section entitled POSITION STATEMENT.

PROGRAM EXCEPTIONS:

Federal Employee Program (FEP): Follow FEP guidelines.

State Account Organization (SAO): Follow SAO guidelines.

Medicare Advantage products:

The following Local Coverage Determination (LCD) was reviewed on the last guideline reviewed date: Qualitative Drug Screening (L30574) located at fcso.com.

The following article was reviewed on the last guideline reviewed date: MLN MattersĀ® Number:SE1105 Medicare Drug Screen Testing located at cms.gov.

DEFINITIONS:

No guideline specific definitions apply.

RELATED GUIDELINES:

None applicable.

OTHER:

None applicable.

REFERENCES:

  1. American Society of Addiction Medicine. Public Policy Statement On Drug Testing as a Component of Addiction Treatment and Monitoring Programs and in Other Clinical Settings. Revised October 2010.
  2. Brandhorst G, et al. Liquid Chromatography–Tandem Mass Spectrometry or Automated Immunoassays: What Are the Future Trends in Therapeutic Drug Monitoring? Clinical Chemistry 58:5 821–825 (2012).
  3. Centers for Medicare & Medicaid Services (CMS), MLN Matters, Number:SE1105 Medicare Drug Screen Testing, August 2009.
  4. Christo PJ, et al. Urine drug testing in chronic pain. Pain Physician. 2011 Mar-Apr;14(2): 123-143.
  5. First Coast Service Options, Inc. (FCSO), Local Coverage Determination: Qualitative Drug Screening (L30574), 02/13/11.
  6. Gourlay DL, Heit HA, Caplan YH. Urine Drug Testing in Clinical Practice. The Art and Science of Patient Care. Edition 4. Sponsored by the California Academy of Family Physicians. 2010.
  7. U.S. Preventive Services Task Force (USPSTF), Screening for Illicit Drug Use. Release Date: January 2008. Accessed at uspreventiveservicestaskforce.org 09/18/13.

COMMITTEE APPROVAL:

This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 11/05/13.

GUIDELINE UPDATE INFORMATION:

11/15/13

New Medical Coverage Guideline.

Private Property of Blue Cross and Blue Shield of Florida.
This medical policy (medical coverage guideline) is copyright 2013, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2013 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

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Date Printed: April 23, 2014: 11:16 PM