CurrentCareSourcePolicy Drug Testing-AR PASSE-MM-1332

Drug Testing — Arkansas PASSE

Defines medical necessity, documentation, billing, and clinical expectations for presumptive and definitive drug testing for Arkansas PASSE members, including requirements for MAT providers and laboratory documentation. Applies to providers serving Arkansas Medicaid members under the PASSE program.

Policy Summary

PayerCareSource

PolicyDrug Testing — Arkansas PASSE coverage criteria

Policy CodePolicy Drug Testing-AR PASSE-MM-1332

Change TypeNo material changes

Effective DateOct 1, 2025

Next Review DateMay 31, 2026

Key ActionUse presumptive testing first and document clinical justification when ordering any definitive (confirmatory) assay.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

ArkansasGeographic scope

8Minimum OTP UDTs/year

$500Annual lab review threshold

80305-80307Presumptive CPT codes

Coverage and Medical Necessity

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General medical necessity: Testing must be individualized, clinically meaningful, and documented in the member record; drug testing supports diagnosis or treatment of SUD, adherence monitoring, detection of illicit use or diversion and must meet standards of good medical practice.

Supports use across phases of treatment; ethical justification required

Presumptive testing: Presumptive (qualitative) urine testing may be billed one code per date of service using CPT 80305-80307 and is encouraged as clinically appropriate for detecting most opioids, benzodiazepines, and illicit drugs.one code per date of service

Providers encouraged to use presumptive methods

Definitive testing: Definitive (confirmatory/quantitative) testing is covered when presumptive results are insufficient to guide care or to identify specific opioids/unidentified agents; each definitive assay must be supported by documentation of specific necessity.document clinical necessity per assay

Definitive testing should not be routine following negative presumptive without discussion

MAT program testing frequency: For MAT continuing treatment first year: at least 1 follow-up MAT office visit per month with drug testing at each monthly visit; maintenance (subsequent years): at least quarterly follow-up with drug testing at each quarterly visit.monthly in year 1; quarterly thereafter

Applies to providers following SAMHSA guidelines

Opioid Treatment Program (OTP) requirements: OTP maintenance requires initial toxicology plus 8 random UDT screens per year; short-term detox requires 1 initial UDT; long-term detox requires initial and monthly random UDTs.8 random UDTs/year for OTP maintenance

Per federal OTP regulations

Not Medically Necessary

Testing considered not medically necessary when any of the following apply

Non-individualized/administrative testing: Reflexive, routine, preprinted orders, testing all machine panels without clinical justification, large arbitrary panels, universal testing, or 'conduct additional testing as needed' orders.

Administrative or non-individualized testing is NMN

Third-party or non-clinical required testing: Court-ordered, pre-employment, forensic, school/military, residential condition-of-stay, primary pay source required testing, physician health programs, marriage license or other administrative purpose testing.

Excluded uses

Method/location exclusions: Blood drug testing outside an emergency department (ED), and hair, saliva, or other body fluid testing for controlled substance monitoring.

These specimen types or out-of-ED blood testing are NMN

Routine definitive testing after negative presumptive: Routine use of definitive testing following a negative presumptive result or prior to discussing presumptive results with the member.

Not medically necessary

Any testing without medical necessity documentation: Any type of drug testing not addressed in this policy or without documentation of medical necessity.

Documentation required

The policy excludes coverage for drug testing that is required by third parties or performed for non-clinical/administrative purposes. Examples include court-ordered testing (including medico-legal matters such as child custody), pre-employment or random employment testing, physician health program testing, school/military testing, condition-of-stay testing for residential programs, testing required by a primary pay source (county, state, or federal agency), marriage-license or other administrative testing, and forensic testing. Additionally, testing performed on blood when drawn outside an emergency department, and testing using hair, saliva, or other non-urine body fluids for controlled-substance monitoring are not covered. Any drug testing not addressed by the policy or lacking documentation of medical necessity is also excluded.

Routine reflexive or non-individualized definitive testing is not medically necessary. Specifically, the policy lists as NMN the routine use of definitive (confirmatory) testing after a negative presumptive result or performing definitive assays before reviewing and discussing presumptive results with the member. The policy also identifies orders that request all tests from a machine because a positive result is possible, large or arbitrary panels, universal testing, and preprinted or 'conduct additional testing as needed' orders as examples of non-individualized testing that will be denied unless medical necessity and individualized clinical justification are documented.

Billing Codes and Thresholds

Presumptive CPT CodesCPTCovered

80305	Presumptive drug testing, level I
80306	Presumptive drug testing, level II
80307	Presumptive drug testing, level III

Annual laboratory services review threshold — $500 per calendar year for members 21+"

Threshold$500 per calendar year for members age 21 and older

Applies toAnnual laboratory services billed to members 21+

TriggerExceeds threshold triggers medical necessity review for laboratory services

Affected CPT codesPresumptive drug testing CPT codes 80305-80307 may be subject to review when threshold exceeded

Provider Requirements, Documentation, and Denials

Billing Rule

Medical necessity review and affected CPT codes

For members aged 21 and older, a medical necessity review is required after laboratory services billed to a member reach a calendar-year limit of $500 unless testing is billed with applicable modifiers indicating medication-assisted treatment (MAT) for opioid use disorder (OUD). Non-participating (out-of-network) providers: medical necessity review is required for all testing. Presumptive testing (CPT 80305-80307) may be billed once per date of service; validity testing on urine specimens (eg, urinary pH, specific gravity, creatinine, nitrates, oxidants) must not be billed separately. Providers are responsible for ensuring tests are billed in accordance with these requirements and for complying with additional instructions in the Arkansas provider manual.

Affected CPT codes and groups: presumptive drug testing CPT 80305-80307 (one code per date of service)
Validity/urine integrity testing is not separately billable (eg, urinary pH, specific gravity, creatinine, nitrates, oxidants)
Medical necessity review threshold: $500 calendar year limit for members ≥21 (exemption when appropriate MAT/OUD modifiers are used)
Out-of-network providers: all testing requires medical necessity review

Note

Presumptive before definitive testing encouraged

Presumptive testing is encouraged as the initial approach when clinically appropriate. Definitive (confirmatory) testing should be ordered when presumptive testing is insufficient to identify specific opioids or when unexpected or discordant results require confirmation. Providers should document why definitive testing is needed and how the result will affect clinical management before ordering.

Use presumptive tests first when clinically appropriate (CPT 80305-80307)
Order definitive/confirmatory testing only to identify specific analytes not resolved by presumptive testing or to address unexpected results
Document the clinical rationale for definitive testing, including how results will change the plan of care

Documentation Required

Required documentation elements

Maintain comprehensive clinical and laboratory documentation to support medical necessity for each test billed. Copies of results alone are insufficient without an associated provider order and supporting clinical record.

Provider order: must state type of test (presumptive vs confirmatory) and list drugs/drug classes to be tested
Diagnosis (ICD) and any supplemental diagnoses supporting the need for each test
List of all current medications (prescription, OTC) and relevant illicit drug use history
Clinical indication and phase of treatment (assessment, continuing, maintenance)
Current level of care (eg, ASAM level) and member's drug(s) of choice
Days since last drug test and explanation for unexpected results, if applicable
Provider signature and date, and ordering/referring provider PINs (include PCP PIN if applicable)
History & physical, chief complaint, tests and results with documentation of review with member and any follow-up or recommendations
Service/treatment records including prescriptions, referrals, and dates of service for billed components
Documentation of actions taken for recent unexpected test results and member responses
Documentation of member contesting unexpected presumptive results, and results of any pill counts

Denial Risk

Triggers for denial / Not medically necessary examples

Testing that is unlikely to be medically necessary or will be denied includes routine or non-clinically indicated panels, testing ordered solely because a machine can run additional assays, testing required for non-clinical third-party reasons, and certain specimen types or settings as specified below.

Requests for large, arbitrary panels or universal testing, or orders stating 'Conduct additional testing as needed'
Testing requested solely because a result might be positive or requesting all tests from a machine without clinical justification
Tests required by third parties (eg, court-ordered for custody, pre-employment, random employment testing, school/military entry, forensic testing, administrative purposes, physician health programs, or testing required by another pay source)
Blood drug testing performed outside the emergency department
Hair, saliva, or other body fluid testing for controlled substance monitoring when not supported by medical necessity
Any drug testing not addressed in this policy or lacking documentation of medical necessity
Routine use of definitive testing following a negative presumptive result or ordering definitive testing prior to discussing presumptive results with the member

Clinical Rationale

Drug testing is used in clinical care to support assessment and ongoing management of members with substance use disorders or those at risk of misuse or diversion. The policy emphasizes that testing should be clinically justified and individualized: results inform diagnosis, monitor adherence to prescribed medications, detect nonprescribed or illicit substance use, and help identify diversion. The guidance also reinforces ethical use of testing by avoiding routine, non‑individualized panels and by ensuring documentation of clinical indication and necessity.

Key Definitions

Definitive (Confirmatory/Quantitative) Test — definition"

TermDefinitive (Confirmatory/Quantitative) Test

DefinitionA test determining the amount of a substance per unit volume or unit weight of specific drugs or metabolites.

Use casePerformed to quantify drug/metabolite levels or confirm presumptive results when clinically necessary

Presumptive (Qualitative) Test — definition"

TermPresumptive (Qualitative) Test

DefinitionTesting of a substance or mixture to determine the presence or absence of a drug or drug class.

Use caseRapid, initial screening method preferred for routine monitoring; billed with CPT 80305-80307 as appropriate

Medication Assisted Treatment (MAT) — definition"

TermMedication Assisted Treatment (MAT)

DefinitionThe use of Food and Drug Administration (FDA)-approved medications in conjunction with counseling and behavioral therapies to treat substance use.

Provider requirementMAT providers must be licensed in Arkansas and follow SAMHSA guidelines (initial evaluation, follow-up visits, counseling coordination).

Medication-Assisted Treatment (MAT) Specifics

Medication Assisted Treatment (MAT)

MAT provider requirements: MAT providers must be licensed in Arkansas and follow SAMHSA guidelines including initial evaluation, monthly follow-up and testing in year 1, quarterly testing in maintenance, counseling referrals, treatment agreements, and case management responsibilities.

Providers must document compliance and coordinate referrals

Visit and Testing Frequency Limits

MAT office visit with drug testing — visit limit (1)"

Limit1 MAT office visit with drug testing per month during the first year of treatment

ContextRequired as part of continuing treatment in year 1 per SAMHSA-aligned MAT monitoring

DocumentationDrug testing must be performed in conjunction with each monthly visit and documented in the member's record

MAT follow-up visit with drug testing — visit limit (1)"

Limit1 MAT follow-up visit with drug testing per quarter (every 3 months) during maintenance treatment

ContextApplies to maintenance (subsequent years) per SAMHSA-aligned MAT monitoring

DocumentationDrug testing must be performed in conjunction with each quarterly visit and documented in the member's record