BlueCross BlueShield of Tennessee Administrative Services

Urine / Serum Drug Testing for Outpatient Treatment

For Commercial Line of Business Use Only, excluding Federal Employee Programs (FEP)


There are two primary categories of drug testing:

  1. Presumptive testing, also known as qualitative, or point-of-care testing (POCT), or screening. These tests can be performed either in a laboratory or at the place of service. Findings are generally reported as either positive or negative. These tests can be used for monitoring of individuals in outpatient programs.

  2. Confirmatory testing, also known as definitive or combined qualitative/quantitative testing. These tests provide specific identification of types of drugs used and in what amount. These tests can be used in making clinical decisions for individuals in outpatient programs.

An ‘episode’ is defined as either presumptive test(s), OR confirmatory test(s), OR both for the same date of service, ordered by the same provider, billed on the same claim.  (Note: Additional tests may be considered on a case by case basis for members with significant need).

Clinical evidence does not support drug testing using oral fluids or hair.



American Society of Addiction Medicine (ASAM) (2017, July) Consensus Statement: Appropriate use of drug testing in clinical addiction medicine. Journal of Addictive Medicine, 2017; 11:163-173.

BlueCross BlueShield Association. Evidence Positioning System. (12:2017) Drug Testing in Pain Management and Substance Use Disorder Treatment (2.04.98) Retrieved February 12, 2019 from (38 articles and/or guidelines reviewed)

Tennessee Department of Health (2017, January) Tennessee Chronic Pain Guidelines: Clinical Practice Guidelines for Outpatient Management of Chronic Non-Malignant Pain. 2nd Edition. Retrieved May 11, 2017 from

U. S. Code of Federal Regulations (2017, June) Title 42, Part 8.12(f) (6). Drug abuse testing services. Retrieved June 22, 2017 from




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