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)

DESCRIPTION

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.

GUIDELINE

REFERENCES

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 https://www.evidencepositioningsystem.com/. (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 https://www.tn.gov/assets/entities/health/attachments/ChronicPainGuidelines.pdf.

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

ORIGINAL EFFECTIVE DATE:  6/1/2018

MOST RECENT REVIEW DATE:  2/12/2019

ID_THM

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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