CurrentArizona Complete HealthPolicy CC.PP.056

Payment Policy: Urine Specimen Validity Testing

Defines payment and billing rules for urine specimen validity (adulteration) testing for all product types and provider laboratory settings; affects physicians, independent and reference laboratories, and payers administering benefits.

Policy Summary

PayerArizona Complete Health

PolicyUrine Specimen Validity Testing

Policy CodePolicy CC.PP.056

Change TypeNo material changes

Effective DateNov 1, 2017

Next Review Date

Key ActionDo not separately bill validity/adulteration testing (e.g., creatinine, pH, specific gravity, oxidants) when performed as part of urine drug testing; it is included in definitive drug test codes and will be denied if billed separately.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

80305-80377, 83992, G0480-G0483, G0659Definitive codes include validity

82570, 83986Not separately reimbursed

ALLProduct types

Physician; Independent; Qualified Hosp; Referring; ReferenceProvider settings

6Defined terms

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Coverage and Billing Criteria for Urine Specimen Validity Testing

Specimen validity billing criteria

Covered when ALL of the following billing rules are met:

Validity/adulteration testing (e.g., urinary pH, specific gravity, creatinine, nitrates, oxidants) performed to confirm specimen integrity is considered incidental to definitive urine drug testing and is not separately reimbursable when performed with definitive urine drug test procedures.

Definitive urine drug testing procedure codes that include specimen validity when performed include ranges 80305-80377, G0480-G0483, plus codes 83992 and G0659; when specimen validity testing is performed as part of these procedures it should not be billed separately.

Claims with specimen validity procedure codes 82570 (Creatinine; other source) or 83986 (pH; body fluid, not otherwise specified) billed separately in conjunction with definitive urine drug testing codes (80305-80307, 80320-80377, 83992, G0480-G0483, G0659) will be denied by the plan's claim editing system.

Validity testing is considered an internal control process and not separately reportable; separate reimbursement for these tests will be disallowed under this policy.

General policy application

General coverage and application guidance:

This payment policy is a guide to payment and assists in coverage and payment determinations but does not constitute a contract or guarantee of payment; coverage and payment are subject to the terms, conditions, exclusions and limitations of the member's coverage documents and applicable state and federal requirements.

Providers are expected to follow contract terms, plan-level administrative policies, and applicable legal and regulatory requirements; Health Plan may change, amend, or withdraw this policy at any time.

For Medicare members, applicable Medicare National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) should be reviewed and supersede this policy where applicable.

This policy is not medical advice and is not intended to dictate clinical practice; providers retain responsibility for clinical judgment and member care.

Applicable Codes and Code Guidance

Specimen validity and definitive urine drug testing codesCPTCovered

80305-80307	Presumptive drug tests; includes sample validation when performed
80320-80377	Definitive drug testing codes (various analytes/classes); includes sample validation when performed
83992	Phencyclidine (PCP)
G0480-G0483	Definitive drug tests (1-22+ classes); includes specimen validity testing
G0659	Definitive drug test without method-specific calibration; includes specimen validity testing
80326	Amphetamines; 5 or more
80355	Fentanyl

Referenced code sourcesmixed

CPT (per 2016)	Current Procedural Terminology referenced
HCPCS Level II (per 2016)	HCPCS referenced
NCCI Chapter X	CMS NCCI Policy Manual, Chapter X, Pathology and Laboratory Services

Drug class count thresholds (G0480–G0483)

G04801-7 drug classes per day

G04818-14 drug classes per day

G048215-21 drug classes per day

G048322 or more drug classes per day

Provider Billing Rules and Obligations

Billing Rule

Do not separately bill validity/adulteration testing

Do not separately bill validity/adulteration testing when performed as part of urine drug testing. Validity testing (eg, urinary pH, specific gravity, creatinine, nitrates, oxidants, or other tests to confirm a specimen is not adulterated) is considered an internal control and is not separately reportable when performed with definitive urine drug testing. Confirmation testing is incidental to the urine definitive drug test and clinically integral to the primary procedure. Laboratory procedure codes in the 80305-80377 and G0480-G0483 ranges, along with 83992 and G0569 include sample validation when performed.

Affected codes include 80305-80377, G0480-G0483, 83992, G0569
Do not separately bill code 82570 (Creatinine other source) when billed with 80305-80307, 80320-80377, 83992, G0480-G0483, G0569

Note

Provider obligations and policy applicability

Coverage and payment determinations are subject to the terms and conditions of the member's coverage documents and applicable state and federal requirements. This payment policy is a guide to payment and does not constitute a contract, guarantee of payment, or medical advice. Providers are expected to exercise professional judgment and remain responsible for medical care. Health Plan may change or withdraw this payment policy and will follow applicable legal and regulatory requirements when doing so.

Defined Terms

Adulteration (specimen validity) testing

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

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

Billing implicationWhen performed with urine drug testing, validity/adulteration testing is considered incidental and should not be billed separately.

Provider laboratory types

Physician Office LaboratoryA laboratory maintained by a physician or group of physicians for performing diagnostic tests in connection with the physician practice.

Qualified Hospital Laboratory

Policy Summary

PayerArizona Complete Health

PolicyUrine Specimen Validity Testing

Policy CodePolicy CC.PP.056

Change TypeNo material changes

Effective DateNov 1, 2017

Next Review Date

SourceLink

On This Page

Policy applicability is subject to the member's evidence of coverage, contract, or certificate of coverage
Providers are independent contractors and are responsible for medical advice and treatment
Health Plan may amend or withdraw this policy; statutory/regulatory requirements govern in case of discrepancy

A laboratory that provides some clinical laboratory tests 24 hours a day, 7 days a week to serve a hospital emergency room; requires physicians available within 30 minutes via call roster and laboratory technologists on duty or on call at all times.

Independent LaboratoryA laboratory independent of an attending/consulting physician's office and independent of a hospital that meets emergency hospital requirements under §1861(e) of the Social Security Act.

Qualified Hospital Laboratory

Qualified Hospital LaboratoryProvides some clinical laboratory tests 24 hours a day, 7 days a week to serve a hospital emergency room; hospital must have physicians physically present or available within 30 minutes via medical staff call roster and laboratory technologists on duty or on call at all times.

Independent Laboratory

Independent LaboratoryIndependent of an attending or consulting physician's office and of a hospital that meets emergency hospital requirements under §1861(e) of the Social Security Act.

Referring Laboratory

Referring LaboratoryA Medicare-approved laboratory that receives a specimen to be tested and refers the specimen to another laboratory for performance of the test.

Reference Laboratory

Reference LaboratoryA Medicare-enrolled laboratory that receives a specimen from a referring laboratory and actually performs the test.

Definitive Drug Testing

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

Additional Information

Additional InformationNot Applicable.