Effective March 1, 2014, Harvard Pilgrim will implement new reporting and reimbursement rules for urine drug testing in addition to those noted in the current Laboratory and Pathology Payment Policy. The new Urine Drug Testing Payment Policy is aimed at ensuring that drug and alcohol testing is appropriate and medically necessary to detect alcohol, drugs, or drug metabolites as part of medical treatment for alcohol or substance abuse.
While existing medical literature supports qualitative testing (CPT 80102; which reveals the presence or absence of a substance) as part of a medical treatment plan for alcohol or substance abuse, it does not support routine quantitative testing (which provides the level of a given substance in the sample). The new payment policy is consistent with current medical literature. Under the new payment policy, Harvard Pilgrim will no longer reimburse:
- Quantitative urine drug testing when no underlying qualitative test has been performed or when the qualitative test is negative
- Quantitative urine drug testing reported with the same date of service as qualitative testing
- Qualitative urine testing reported under CPT codes 80100, 80101, or 80104
- Services for custom profile requisitions without individual orders specific to the member’s individual treatment plan
- More than 20 dates of service per calendar year for all urine drug screening tests
In addition, Harvard Pilgrim does not reimburse testing for residential monitoring purposes. Please refer to the new Urine Drug Testing Payment Policy in our Provider Manual for complete policy and coding information.