CurrentBlue Cross Blue Shield - OklahomaPolicy CPCP020

Drug Testing Clinical Payment and Coding Policy

Defines reimbursement, coding, documentation and CLIA requirements for presumptive and definitive drug testing claims submitted to Blue Cross and Blue Shield of Oklahoma; affects providers and laboratories submitting urine and other matrix drug testing claims.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyDrug Testing Clinical Payment and Coding Policy

Policy CodePolicy CPCP020

Change TypeNo material change

Effective DateNov 14, 2024

Next Review Date

Key ActionProviders may only bill for services they perform; orders must be signed and dated, list each specific drug or drug class, and be patient-specific.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

80305-80307Presumptive CPTs considered

G0480-G0483, G0659Definitive HCPCS considered

1 per DOSOne definitive G code per DOS

IncludedValidity testing billing

RequiredCLIA requirement

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Coverage Criteria and Rules

Coverage criteria and rules

Coverage is conditional on correct coding, complete documentation, CLIA certification, and medical necessity consistent with MED207.154. Reimbursement will be considered when all applicable requirements below are met.

ALL of the following

ANY of the following
- CPT 80305 — Presumptive drug test, direct optical observation
- CPT 80306 — Presumptive drug test, instrument-assisted direct optical observation
- CPT 80307 — Presumptive drug test, instrumented chemistry analyzers
ANY of the following
- HCPCS G0480 — Definitive drug test, 1–7 drug classes (includes specimen validity testing)
- HCPCS G0481 — Definitive drug test, 8–14 drug classes (includes specimen validity testing)
- HCPCS G0482 — Definitive drug test, 15–21 drug classes (includes specimen validity testing)
- HCPCS G0483 — Definitive drug test, 22+ drug classes (includes specimen validity testing)
- HCPCS G0659 — Definitive drug test, any number of classes (method not requiring method-specific calibration or isotope standards)

ALL of the following

A provider may only bill for services the provider performs; pass-through billing of third-party performed services is not permitted.
Only one definitive G code may be billed per date of service.
Specimen validity testing is included in the base definitive testing codes and may not be billed separately.

ALL of the following

Orders must be signed and dated by the ordering health care professional.
Each drug or drug class being tested must be explicitly listed on the order; reference to a standard order, custom panel, or standing order is not acceptable; reflex/automatic testing is not acceptable.
The requisition must include patient identity, ordering provider name/credentials/NPI, legible provider signature (not a stamp), collection facility/location, sample type, collection date/time, identity of collector, and date/time received by the laboratory.

ALL of the following

Performing entity identification (name, address, CLIA number) must be included in lab results.
Lab results must include patient name/DOB, ordering provider name and NPI, facility name if applicable, dates of collection/receipt/reporting, and complete test results (including validity testing if performed).
Performing provider or laboratory must possess a valid CLIA certificate for the type of testing performed.

ALL of the following

Definitive (quantitative) testing should generally follow presumptive (qualitative) testing and be ordered when documentation supports unexpected or specific results as described in MED207.154.
If definitive testing is ordered without prior presumptive testing, the medical record must document the clinical justification for definitive testing for that patient (e.g., inability to obtain urine, unexpected presumptive results, or other clinically supported rationale).
Routine, non‑individualized quantitative panels performed as part of a protocol, standing orders, or reflex/automatic testing without documented individual patient assessment are not reimbursable.

ALL of the following

Claims will be denied if documentation requirements are not met; complying with requisition/documentation elements does not guarantee reimbursement.
This policy does not address state, federally regulated, or legally mandated drug testing (e.g., court‑ordered or forensic testing).

ALL of the following

Independent laboratory claims should be submitted to the Blue Cross and Blue Shield plan in the state where the referring/ordering provider is located, regardless of where the laboratory is located.

Coding and Billing Details

Presumptive (qualitative) screeningCPTCovered

80305	DRUG TEST PRSMV DIR OPT OBS
80306	Presumptive drug test, instrument-assisted direct optical observation
80307	Presumptive drug test, instrumented chemistry analyzers

Definitive (quantitative) testingHCPCSCovered

G0480	Definitive drug test, 1-7 drug classes, includes specimen validity testing
G0481	Definitive drug test, 8-14 drug classes, includes specimen validity testing
G0482	Definitive drug test, 15-21 drug classes, includes specimen validity testing
G0483	Definitive drug test, 22 or more drug classes, includes specimen validity testing
G0659	Definitive drug test without method-specific calibration or isotope standards; any number of classes

Drug class count per definitive G code

G04801-7 drug classes (definitive) — includes specimen validity testing

G04818-14 drug classes (definitive) — includes specimen validity testing

G048215-21 drug classes (definitive) — includes specimen validity testing

G048322 or more drug classes (definitive) — includes specimen validity testing

One definitive G code per date of service

Billing limitOnly one (1) definitive G code (G0480, G0481, G0482, G0483, or G0659) may be billed per date of service

Provider Billing and Ordering Requirements

Billing Rule

Billing and order requirements for presumptive and definitive testing

Reimbursement will be considered for presumptive CPT codes 80305, 80306, and 80307 and for definitive HCPCS codes G0480, G0481, G0482, G0483, and G0659. A provider may only bill for services the provider performs; pass-through billing of services performed by a third party is not permitted. Orders must be signed and dated and list each specific drug or drug class; custom panels, standing orders, reflex/automatic testing, and routine definitive panels without individual assessment are not reimbursable. Specimen validity testing is included in the base definitive codes and may not be billed separately.

Presumptive CPT codes considered: 80305, 80306, 80307
Definitive HCPCS codes considered: G0480, G0481, G0482, G0483, G0659
Providers may only bill for services they perform (no pass-through billing)
Orders must be patient-specific, signed and dated, and list each specific drug or drug class
Custom panels, standing orders, reflex/automatic testing, and routine definitive panels without individual assessment are not reimbursable
Validity testing is included in the base definitive codes and may not be billed separately

Key Definitions

Presumptive testing (CPT 80305-80307)

DefinitionPresumptive (qualitative) drug screening refers to qualitative drug class screening performed using direct optical observation or instrument-assisted/chemistry analyzers (CPT 80305, 80306, 80307).

Typical methodsDirect optical observation; instrument-assisted direct optical observation; instrumented chemistry analyzers (e.g., immunoassay, enzyme assay)

Billing noteTest includes specimen validity testing in the base code and may be performed only once per date of service

Definitive testing (G0480-G0483, G0659)

DefinitionDefinitive (quantitative) drug testing identifies individual drugs and distinguishes structural isomers using methods such as GC/MS or LC/MS (single or tandem); codes include G0480-G0483 and G0659.

Method requirements (G0480-G0483)