This policy defines the daily limits for presumptive drug testing codes and definitive drug testing codes, and addresses Specimen Validity Testing.
All services described in this policy may be subject to additional UnitedHealthcare reimbursement policies including, but not limited to, the Maximum Frequency Per Day Policy, Laboratory Services Policy, and CCI Editing Policy.
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Q: Will UnitedHealthcare reimburse more than one presumptive and/or one definitive drug test on the same date of service if a modifier is appended?
A: No, each of the presumptive and definitive drug codes define a single manual or automated laboratory service that is reported once per day, per patient, irrespective of the number of Drug Classes, sample validations, or Specimen Validity Tests performed related to that service on any date of service. In accordance with the CPT and CMS guidelines UnitedHealthcare will not reimburse more than one presumptive and/or one definitive drug test per day regardless of the number of billing providers.
Q: Will UnitedHealthcare consider separate reimbursement for laboratory service (Ex: urinalysis for urinary tract infection) performed on the same day as a drug screening test?
A: Yes, UnitedHealthcare will consider separate reimbursement of laboratory services that are appended with an appropriate modifier to identify the test was distinctly separate and not related to drug testing as a Specimen Validity Test. The records must also support that the laboratory service performed was not for Specimen Validity Testing and the modifier was appropriately reported. Please refer to the Modifier Reference Policy for additional modifier information.
Q: What is the difference between Presumptive and Definitive testing?
A: A presumptive test is one used to identify possible use or non-use of a drug or Drug Class. Presumptive tests are not definitive. They only screen for the presence of a compound. A definitive or confirmation test is one that uses instrument analysis to positively identify the presence or quantity of a drug.