CurrentAmbetter NevadaPolicy CC.PP.056

Payment Policy: Urine Specimen Validity Testing

Defines payment and billing criteria for urine specimen validity (adulteration) testing and which laboratory providers and procedure codes are affected for Ambetter Nevada.

Policy Summary

PayerAmbetter Nevada

PolicyPayment Policy: Urine Specimen Validity Testing

Policy CodePolicy CC.PP.056

Change TypeAdministrative review (no material changes)

Effective Date

Next Review Date

Key ActionDo not bill specimen validity/adulteration testing separately when billed with definitive urine drug test codes; such separate claims will be denied.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2specific CPT/HCPCS codes explicitly listed as not covered

80305-80377procedure code ranges that include specimen validation when performed

5listed applicable facility types

1utilization/code edit rule

Centenecopyright / ownership

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage Criteria

Payment and billing rules for specimen validity testing:

Validity/adulteration testing performed to confirm a urine specimen is unadulterated is not separately reimbursable and should not be billed separately.

Definitive and presumptive urine drug testing procedure codes include specimen validation when performed and reimbursement for validity testing is considered inclusive (not separately payable).

Policy cites code ranges 80305-80377, G0480-G0483, G0659, and code 83992 as including sample validation when performed.

When billed with definitive testing codes, procedure codes 82570 (Creatinine; other source) and 83986 (pH; body fluid, not otherwise specified) will be denied by the plan's code editing software.

Specimen validity codes 82570 and 83986 are identified as not covered when billed with the listed definitive testing ranges.

General coverage stance

This payment policy provides guidance but does not guarantee payment; coverage is subject to plan documents, state Medicaid provisions, and applicable NCDs/LCDs for Medicare.

This payment policy is a guide to payment and does not constitute a contract or guarantee regarding payment or results; coverage and payment determinations are subject to all terms, conditions, exclusions and limitations of the applicable coverage documents and plan-level policies.

State Medicaid provisions take precedence over this policy when conflicts exist; refer to the state Medicaid manual for applicable coverage provisions.

For Medicare members, review all applicable National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) prior to applying this payment policy.

This payment policy is the property of Centene Corporation; unauthorized copying or distribution is prohibited.

Procedure Codes and Edit Rules

Validity and definitive urine drug testing codesmixedCovered

82570	Creatinine; other source
83986	pH; body fluid, not otherwise specified
80305-80307	Presumptive drug tests (includes sample validation when performed)
80320-80377	Definitive/presumptive drug testing codes
83992	Phencyclidine (PCP)
G0480-G0483	Definitive drug testing (includes specimen validity testing)
G0659	Definitive drug testing without certain quality controls (includes specimen validity testing)

Referenced coding manualsmixed

CPT (2025)	Referenced as coding source
HCPCS Level II (2025)	Referenced as coding source

inv-05: Code edit denial rule

Code edit denial rule82570 (Creatinine; other source) is denied when billed with 80305-80307, 80320-80377, 83992, G0480-G0483, G0659; 83986 (pH; body fluid, NOS) is denied when billed with 80305-80307, 80320-80377, 83992, G0480-G0483, G0659.

Affected definitive/presumptive rangesDenials apply when 82570 or 83986 are billed with codes in the 80305-80377 range.

Affected HCPCS seriesDenials apply when 82570 or 83986 are billed with G0480-G0483 or G0659.

Specific standalone code listed83992 (PCP) is included among codes that trigger denial when billed with 82570 or 83986.

Provider Billing Actions and Payment Determinations

Prior Authorization

Prior Authorization Required / Denial Risk for Separate Validity Testing

Providers that perform validity/adulteration testing on urine specimens should not separately bill for this testing. Confirmation testing is considered incidental to the more complex procedure (urine definitive drug test) and is clinically integral to the successful outcome of the primary procedure. Per CMS National Correct Coding Initiative (Chapter X Pathology and Laboratory Services), validity testing used to confirm a specimen is unadulterated (for example urinary pH, specific gravity, creatinine, nitrates, oxidants, or other specimen integrity tests) is not separately billable when performed in conjunction with definitive urine drug testing.

Do not separately bill validity/adulteration testing when performed with definitive urine drug testing (included with 80305-80377, G0480-G0483, 83992, G0569).
Code edit/claim denials: 82570 (Creatinine; other source) will be denied when billed with 80305-80307, 80320-80377, 83992, G0480-G0483, G0659; 83986 (pH; body fluid, NOS) will be denied when billed with 80305-80307, 80320-80377, 83992, G0480-G0483, G0659.

Denial Risk

General Payment Determinations

The health plan will disallow separate reimbursement for testing performed solely to confirm that a urine drug specimen is unadulterated. Validity testing performed as an internal control or sample validation is considered incidental and is not separately reportable. The plan's code editing software may automatically deny or edit claims that report standalone validity/adulteration codes alongside definitive urine drug test codes.

Reimbursement for validity/adulteration testing performed with definitive urine drug testing is included in the definitive test payment and will be disallowed as a separate line item.
This policy is a guide for payment determinations; actual coverage and payment are subject to the terms, exclusions, limitations, and administrative rules of the member's benefit plan and applicable law.
Health Plan retains the right to change, amend, or withdraw this payment policy and to apply plan-level edits and adjudication rules.

Definitions and Facility Types

inv-08: Adulteration testing definition — tampering or manipulation of a urine specimen

DefinitionAdulteration testing is the tampering or manipulation of a urine specimen with the intention of altering the test results, which can cause false negative results by destroying drugs present or interfering with screening.

Clinical intentPerformed to confirm that a urine specimen is not adulterated (e.g., pH, specific gravity, creatinine, nitrates, oxidants).

Billing guidancePer CMS/NCCI guidance, validity/adulteration testing performed to confirm specimen integrity should not be billed separately when performed with definitive drug testing.

inv-09: Physician's Office Laboratory definition

DefinitionA physician office laboratory is a laboratory maintained by a physician or group of physicians for performing diagnostic tests in connection with the physician practice.

SettingLocated within or operated by a physician practice to support diagnostic testing for that practice.

ScopePer policy, included in listed applicable facility types for specimen validity testing guidance.

inv-10: Qualified Hospital Laboratory definition

DefinitionA qualified hospital laboratory provides some clinical laboratory tests 24 hours a day, 7 days a week, to serve a hospital's emergency room and is available to provide services continuously.

Staffing requirementHospital must have physicians physically present or available within 30 minutes via call roster and laboratory technologists on duty or on call at all times.

PurposeEnsures timely testing services for emergency room needs around the clock.

inv-11: Independent Laboratory definition (short)

DefinitionAn independent laboratory is independent of an attending or consulting physician's office and of a hospital that meets requirements to qualify as an emergency hospital per §1861(e) of the Social Security Act.

IndependenceNot part of a physician office or qualifying emergency hospital.

Regulatory basisDefined with reference to the Social Security Act criteria in the policy.

inv-12: Referring Laboratory definition (short)

DefinitionA referring laboratory is a Medicare‑approved laboratory that receives a specimen to be tested and refers the specimen to another laboratory for performance of the test.

FunctionAccepts specimens and forwards them to another laboratory for testing.

Medicare contextTerm used consistent with Medicare approval and referral processes.

inv-13: Independent Laboratory definition (alternate/expanded)

Expanded definitionAn independent laboratory is one that is independent both of an attending or consulting physician's office and of a hospital that meets at least the requirements to qualify as an emergency hospital as defined in §1861(e) of the Social Security Act.

ImplicationMeets statutory independence criteria distinguishing it from physician office or qualifying hospital labs.

RelevanceUsed to determine applicability of specimen validity testing billing guidance.

inv-14: Referring Laboratory definition (alternate/expanded)

Expanded definitionA referring laboratory is a Medicare‑approved laboratory that receives a specimen to be tested and refers the specimen to another laboratory for performance of the laboratory test.

Role distinctionDistinguished from a reference laboratory, which actually performs the testing.

Operational noteReferring labs may forward specimens to reference laboratories for definitive testing or services beyond their capability.

inv-15: Reference Laboratory definition

DefinitionA reference laboratory is a Medicare‑enrolled laboratory that receives a specimen from another referring laboratory for testing and that actually performs the test.

RolePerforms the laboratory test on specimens sent from referring laboratories.

Medicare enrollmentSpecifies the lab is Medicare‑enrolled, per the policy definitions.

inv-16: Definitive Drug Testing definition

DefinitionDefinitive drug testing comprises identification methods that can identify individual drugs and detect possible use or non-use of a drug; these tests may be qualitative or quantitative.

Includes specimen validationPolicy states that laboratory procedure codes in the 80305-80377 and G0480-G0483 ranges, along with 83992 and G0569/G0659, include sample validation when performed.

Billing implicationWhen performed, specimen validity testing is considered incidental to definitive drug testing and should not be billed separately.

OpenPayer

Payment Policy: Urine Specimen Validity Testing

Coverage and Billing Criteria

Procedure Codes and Edit Rules

Provider Billing Actions and Payment Determinations

Definitions and Facility Types