Summary & Overview
CPT 0093U: ComplyRX™ LC–MS/MS Urine Multi-Drug Screen
CPT code 0093U designates the ComplyRX™ Proprietary Laboratory Analysis (PLA) from Claro Labs, a urine-based LC–MS/MS assay that detects 65 common prescription drugs. As a PLA code, 0093U maps to a single manufacturer-specific test and is used where payers and providers need to identify this unique laboratory service precisely. Nationally, PLA codes matter because they enable visibility and tracking for proprietary diagnostics that may affect utilization management, lab contracting, and coverage policy.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context and intended use, payer coverage landscape, and typical settings where the service is performed. The publication summarizes benchmark metrics, common billing considerations, and recent policy developments affecting proprietary lab tests, helping billing teams and policy analysts understand reimbursement and administrative implications for a national audience.
This summary covers what the code represents, why it matters, common payer considerations, and the kinds of benchmarks and policy updates addressed in the full publication. Data not available in the input will be noted and omitted from specific tables and charts.
Billing Code Overview
CPT code 0093U is a Proprietary Laboratory Analyses (PLA) code for the ComplyRX™ test developed by Claro Labs. The test uses liquid chromatography–tandem mass spectrometry (LC–MS/MS) of a urine specimen to determine the presence or absence of 65 common prescription drugs in a patient’s body.
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Service type: Clinical laboratory test using LC–MS/MS for multi-drug urine screening
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Typical site of service: Clinical laboratory or outpatient collection site where urine specimens are obtained and sent to the performing laboratory
Clinical & Coding Specifications
Clinical Context
A patient enrolled in an opioid use disorder monitoring program presents to an outpatient laboratory or addiction medicine clinic for urine drug testing using the ComplyRX™ assay. The clinician orders 0093U to detect presence or absence of 65 common prescription medications and their metabolites by liquid chromatography–tandem mass spectrometry (LC–MS/MS) on a urine specimen. Typical clinical workflow: a trained phlebotomy or laboratory collection technician obtains a secured urine sample following chain-of-custody and facility collection protocols; the specimen is sent to Claro Labs or an authorized performing laboratory; the laboratory performs LC–MS/MS analysis and generates a report indicating detected substances and qualitative interpretations; results are routed to the ordering clinician for review during follow-up visits or medication management decisions. Typical sites of service include outpatient laboratories, addiction medicine clinics, primary care clinics with specimen collection, and ambulatory behavioral health centers. Indications include monitoring adherence to prescribed controlled substances, confirming reported medication use, monitoring for illicit drug use, pre- and post-treatment surveillance for pain management or substance use disorder programs, and medico-legal or occupational drug testing when a broad prescription panel is required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional interpretation portion of the test is billed separately by a physician or qualified healthcare professional. |
TC | Technical component | Use when only the laboratory technical component (performing the assay) is billed by the performing laboratory. |
59 | Data not available in the input. | Data not available in the input. |
QX | Data not available in the input. | Data not available in the input. |
QY | Data not available in the input. | Data not available in the input. |
QK | Data not available in the input. | Data not available in the input. |
Q0 | Data not available in the input. | Data not available in the input. |
00 | Default or no modifier required | Use when no additional modifier is applicable; report the code alone. |
11 | Data not available in the input. | Data not available in the input. |
22 | Unusual procedural services | Use when the laboratory or performing provider documents unusually high complexity or work performed for the assay beyond the typical described service. |
52 | Reduced services | Use when testing is partially reduced or specimen is inadequate for full panel performance but partial testing is performed. |
53 | Discontinued procedure | Use when testing was started but discontinued for documented clinical reasons prior to completion. |
90 | Data not available in the input. | Data not available in the input. |
78 | Unplanned return to OR by same physician | Data not applicable to laboratory testing; not typically used for 0093U. |
GQ | Data not available in the input. | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208D00000X | Addiction Medicine | Common ordering specialty for prescription monitoring panels and adherence testing. |
208000000X | Family Medicine | Primary care physicians managing chronic pain or opioid therapy may order this test. |
207L00000X | Emergency Medicine | Emergency clinicians may order broad urine drug testing in acute presentations. |
207P00000X | Internal Medicine | Internists managing chronic medications and substance use monitoring may order this assay. |
3336C0002X | Clinical Pathology / Laboratory | Performing laboratories and pathologists oversee testing quality and result interpretation. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
F11.20 | Opioid dependence, uncomplicated | Frequent indication for urine monitoring to assess adherence and detect non-prescribed opioids. |
F11.21 | Opioid dependence, in remission | Monitoring for relapse or medication adherence in recovery programs. |
Z20.820 | Contact with and (suspected) exposure to COVID-19 | Data not clinically specific; not typically directly related to this assay. |
R78.89 | Other specified abnormal blood chemistry | May be used when abnormal toxicology findings prompt further specific testing. |
Z51.89 | Encounter for other specified aftercare | Used when monitoring is part of ongoing care after treatment for substance use disorder. |
G89.2 | Chronic pain, not elsewhere classified | Chronic pain management programs commonly use urine drug testing for medication monitoring. |
T40.2X5A | Poisoning by other opioids, accidental (initial encounter) | Acute presentations where confirmatory drug testing is clinically indicated. |
Z20.820 | Data not available in the input. | Data not available in the input. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
81002 | Urinalysis, by dipstick or tablet reagent; non-automated, without microscopy | Performed at collection site for initial screening prior to confirmatory LC–MS/MS testing. |
80307 | Drug test(s), presumptive, any number of drug classes; each procedure | May be used for rapid presumptive immunoassay screening before sending specimen for 0093U confirmatory LC–MS/MS. |
83986 | Therapeutic drug assay, cyclosporine | Example of other specific drug quantitation tests; illustrates that specialized assays and panels like 0093U supplement single-drug therapeutic assays. |
G0480 | Drug screen, definitive, each specimen by definitive method (e.g., GC/MS, LC/MS/MS), multiple drug classes (used for Medicare) | Clinically related definitive testing code used by some payors for LC–MS/MS confirmation panels; often used in parallel or as alternative to PLA codes depending on payer policy. |
99000 | Handling and/or conveyance of specimen to laboratory (if applicable) | Ancillary service sometimes billed by facilities to cover specimen handling, courier, or processing logistics related to sending urine specimens to reference labs. |