Outpatient Drug Screen Testing- Facility
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Defines reimbursement rules for outpatient facility claims for presumptive (CPT) and definitive (HCPCS Level II) drug screen testing for Blue Cross Blue Shield - Nevada commercial members.
Added note that this policy does not apply when presumptive drug screen testing (CPT) and definitive drug screen testing (HCPCS Level II) are billed with Partial Hospitalization Program, and Intensive Outpatient Program Revenue codes.
Updated Related Coding Section code list by removing examples.
Updated policy title from Outpatient Drug Screen Billing - Facility and updated Definitions section; added coding link to Related Coding section.
Coverage Criteria
Outpatient facility drug screen coverage criteria
Reimbursement and billing rules for outpatient facility drug screening.
Covered Indications
Outpatient drug screening when medically indicated and properly documented
Definitive testing appropriate to detect substances not identified by presumptive methods or to confirm/refine presumptive results.
Coding
| G0659 | HCPCS Level II definitive drug testing code |
| G0480-G0483 | HCPCS definitive drug screen codes (facility) |
Provider Actions and Requirements
Document orders and confirmatory rationale in the medical record
Provider documentation and the member's medical records must reflect that definitive drug testing was properly ordered; if definitive testing is confirmatory, the documentation must support that the order was based on the presumptive test result.
Follow authorization, medical necessity, and billing guidelines
Services must meet authorization and medical necessity guidelines; failure to follow coding and billing guidelines (including use of industry-standard CPT/HCPCS codes) may result in claim rejection, denial, recovery, or recoupment.
Definitions
Ordering Requirements
Record test orders and base confirmatory testing on presumptive results
Order tests with supporting documentation in the medical record; confirmatory definitive tests should be ordered based on presumptive test results and reflected in the chart.
- Confirmatory definitive testing must be based on presumptive test results when applicable.
- Maintain the order and supporting presumptive result in the member's medical record for audit and reimbursement purposes.
Not Covered
The health plan treats CPT definitive drug testing codes as bundled and therefore not eligible for reimbursement on outpatient facility claims. When HCPCS Level II definitive drug code G0659 is reported in conjunction with G0480, G0481, G0482, or G0483, only G0659 will be eligible for reimbursement. There are no exemptions to this bundling policy.
This policy does not apply when presumptive CPT drug screen testing and definitive HCPCS Level II drug screen testing are billed with Partial Hospitalization Program or Intensive Outpatient Program revenue codes. This exception was added to the policy effective 06/08/2026 and is documented in the policy history.
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