Here from the LCD for Medicare carrier in Texas, in regards to qualt. followed by quantitative testing.
"When a confirmatory test or a quantitative test is performed, the record must show that an inconsistent positive finding was noted on the qualitative testing or that there was no available, commercially or otherwise, qualitative test to evaluate the presence of a semi-synthetic or synthetic opioid in a patient who met the coverage criteria of this policy."
Local Coverage Determination (LCD):
Qualitative Drug Testing (L34352)
Contractor Name
Novitas Solutions, Inc. opens in new window Contract Number
04412 Contract Type
MAC - Part B
http://www.cms.gov/medicare-coverag...t+B)&s=51&DocType=Active&bc=AggAAAIAAAAAAA==&
Below is example of the type of testing that is falling under a quantitative code/Notice they mention liquid chromatography-Tandem Mass Spectrometry which would be seen in a lab setting. They are listing CPT 82542 for THC quantitative testing.
http://ltd.aruplab.com/tests/pub/0090369
Drugs covered: 9-carboxy-THC
Methodology: Liquid Chromatography-Tandem Mass Spectrometry
Positive cutoff: 5 ng/mL
The drug analyte detected in this assay, 9-carboxy THC, is a metabolite of delta-9-tetrahydrocannabinol (THC). Detection of 9-carboxy THC suggests use of, or exposure to, a product containing THC. This test cannot distinguish between prescribed or non-prescribed forms of THC, nor can it distinguish between active or passive use. The 9-carboxy THC metabolite can be detected in urine for several weeks. Normalization of results to creatinine concentration can help document elimination or suggest recent use, when specimens are collected at least one week apart.
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For MDMA/Esctacy, it appears it falls under the amphetamine drug class and they are indicating they are using: 82145
http://ltd.aruplab.com/Tests/Pub/0090439
Drugs covered: methamphetamine, amphetamine, methylenedioxymethamphetamine (MDMA - Ecstasy), methylenedioxyethylamphetamine (MDEA - Eve), and methylenedioxyamphetamine (MDA).
Positive cutoff: 200 ng/mL
The absence of expected drug(s) and/or drug metabolite(s) may indicate non-compliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted/adulterated urine, or limitations of testing. The concentration value must be greater than or equal to the cutoff to be reported as positive. Interpretive questions should be directed to the laboratory