High Complexity Urine Drug Screen 80301, 80302, G0479 & Definitive Drug Screens

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Chicago, IL
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When performing a High Complexity Drug Test 80301, 80302, G0479 are you able to conduct a Definitive Drug Test, when the test you are conducting is commercially available (but is not validated on the particular machine)? When performing the High Complexity Drug Test 80301, 80302, G0479, all the potential commercially available tests are not being ran currently, due to the need for an immediate result for point of care. There are drugs of abuse which could be validated on the high complexity machine, but this would not make the results immediately available for point of care. It would take too much time. Is the clinic obligated to run all the potentially commercially available tests before being able to run the confirmatory tests? If the clinic runs all the potentially commercially available tests, then the results would not be available for point of care.

Another question: For high risk patients and those with aberrant behavior (early refills, dose escalation, etc.), can the clinic spread its net wider to include drugs of abuse not detectable by presumptive testing (and not commercially available)? Also, can the clinic spread its net wider to include drugs of abuse not detectable by presumptive testing (commercially available, but not validated on the particular machine)?

Appreciate the feedback!!!!
 

Walker22

True Blue
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Cumming, GA
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I'm not trying to avoid answering your question, but this is a very complicated situation. Most payers have a written medical policy on this. I suggest you look them up and read them. They explain what you can and cannot do much better than I ever could!
 
Messages
5
Location
Chicago, IL
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I'm not trying to avoid answering your question, but this is a very complicated situation. Most payers have a written medical policy on this. I suggest you look them up and read them. They explain what you can and cannot do much better than I ever could!

Thanks, for taking the time out Walker22! I have read BCBS of IL and CMS, and if read correctly doesn't address this. My employer is actually reaching out to American Academy of Pain Medicine for additional guidance.
 

Walker22

True Blue
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Cumming, GA
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Thanks, for taking the time out Walker22! I have read BCBS of IL and CMS, and if read correctly doesn't address this. My employer is actually reaching out to American Academy of Pain Medicine for additional guidance.

You are welcome. I know for a fact that there are some payer policies that specifically state they allow straight to definitive testing for drugs that are not testable by presumptive methods. There still has to be a medically necessary reason, of course.
 
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