CurrentUnitedHealthcarePolicy Reimbursement Policy CMS-1500 Policy Number 2025R6005I

Drug testing — presumptive, definitive, and specimen validity testing reimbursement limits

Defines daily and annual reimbursement limits and code reporting rules for presumptive (screening) and definitive (confirmation) drug testing and specimen validity testing for UnitedHealthcare Community Plan claims billed on CMS-1500 (and UB04 when specified). Applies to providers billing UnitedHealthcare Community Plan.

Policy Summary

PayerUnitedHealthcare

PolicyDrug testing — presumptive, definitive, and specimen validity testing reimbursement limits

Policy CodePolicy Reimbursement Policy CMS-1500 Policy Number 2025R6005I

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionReport only one presumptive and one definitive drug test per patient per date of service and document any separately billed urinalysis or test with the appropriate modifier and supporting records.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1Allowed presumptive drug test reimbursed per patient per date of service

1Allowed definitive drug test reimbursed per patient per date of service

18Annual limit for presumptive drug testing (dates of service)

18Annual limit for definitive drug testing (dates of service)

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Per-date and Annual Reimbursement Rules

Per-date and annual reimbursement rules

Covered when ALL of the following per‑date and annual reimbursement rules are met:

ALL of the following

Only one presumptive drug test (CPT 80305, 80306, 80307, H0003) is reimbursable per patient per date of service, irrespective of the number of drug classes or specimens provided.
Only one definitive drug test (HCPCS G0480–G0483, G0659; CPT 80320–80377, 83992; and specified PLA codes such as 0007U, 0011U, 0082U, 0328U, 0517U–0520U, 0587U) is reimbursable per patient per date of service.
Specimen validity testing (services to assure a specimen has not been adulterated or substituted) is considered included in the presumptive and definitive drug test CPT/HCPCS code descriptions and is not separately reimbursable when performed on the same date of service as a presumptive or definitive drug test.
An annual frequency limit of 18 reimbursed dates of service applies for presumptive testing and 18 reimbursed dates of service applies for definitive testing, unless a state exception to these limits applies.
If multiple presumptive and/or definitive tests are submitted for the same date of service, only the single reimbursed presumptive and/or single reimbursed definitive code will count toward the respective annual 18‑date limit.
A modifier may be appropriate to indicate a separate, distinct urinalysis or other test performed on the same date of service that is not specimen validity testing; the modifier and supporting documentation must demonstrate the service was performed distinctly separate from the drug test service.

Reimbursement thresholds

Presumptive tests per date1 per patient per date of service

Definitive tests per date1 per patient per date of service

Annual reimbursed dates of service - presumptive18 per calendar year (state exceptions may apply)

Annual reimbursed dates of service - definitive18 per calendar year (state exceptions may apply)

Relevant CPT / HCPCS / PLA Codes

Presumptive drug testing codesCPT|HCPCS|mixedCovered

80305	Drug test, presumptive, any number drug classes; any number of techniques/methods
80306	Drug test, presumptive, multiple drug classes
80307	Drug test, presumptive, other
H0003	Alcohol and/or drug screening; multiple drug classes

Definitive drug testing codes (HCPCS/CPT/PLA)CPT|HCPCS|mixedCovered

G0480	Drug test, definitive, multiple drug classes (HCPCS)
G0481	Drug test, definitive, multiple classes (HCPCS)
G0482	Drug test, definitive, multiple classes (HCPCS)
G0483	Drug test, definitive, multiple classes (HCPCS)
G0659	Definitive drug testing (HCPCS)
80320-80377	CPT definitive drug class codes (specific drug class testing)
83992	Definitive drug class code (CPT) – additional definitive testing
0007U	PLA/proprietary definitive test (example)
0011U	PLA/proprietary definitive test (example)
0082U	PLA/proprietary definitive test (example)

1–10 of 16

1/2

Specimen validity and related codesCPT|HCPCS|mixedNot Covered

81000-81005	Urinalysis/specimen validity related codes (included in drug test codes; not separately reimbursable when same date as drug test)
82542-82570	Drug-specific assays (listed as specimen validity related; included when part of drug testing)
83516-83520	Chemistry/assay codes (specimen validity related)
83789	Analyte testing (specimen validity related)
83986	Analyte testing (specimen validity related)
84156-84311	Misc chemistry/microbiology codes (specimen validity related)

Billing, Documentation, and Denial Risks

Billing Rule

Do not bill multiple presumptive/definitive tests per day

Report only one presumptive and one definitive drug test per patient per date of service. Multiple submissions for the same date will be subject to denial; only the reimbursed code will count toward annual limits.

80305
80306
80307
H0003
G0480
G0481
G0482
G0483
G0659
80320-80377
83992
0007U
0011U
0082U

State-specific Modifications to Limits and Coverage

Multiple state-specific exceptions modify the per-date and annual limits and covered codes described in this policy. Providers must follow applicable state Medicaid rules, as some states are exempt from the standard 18 dates-of-service (DOS) per calendar year limits or impose different unit, monthly, weekly, or code-specific coverage restrictions.

AZ: Per Arizona regulations the state is exempt from the annual 18-DOS limits for presumptive and definitive testing and sets different unit limits: CPT 80305–80307 allow 3 units per week; 12 per month; G0480 allows 1 unit/week; 4/month; G0481 allows 1 unit/week; 2/month; G0482 allows 1 unit/30 days; 2/year; G0483 allows 1 unit/30 days; 6/year (see state exceptions).

FL: Florida is exempt from the annual 18-DOS limits and does not reimburse certain definitive codes (G0480–G0483, G0659, 0007U, 0011U). Definitive testing should be reported using CPT definitive class codes 80320–80377 and 83992 with a limit of 7 different tests per member per day.

ID: Idaho allows 24 presumptive and 12 definitive tests per calendar year under state regulations (i.e., different annual limits than the standard 18 DOS).

MN: Minnesota Medicaid allows 15 presumptive or 15 definitive tests per calendar year; reporting uses CPT 80305–80307 for presumptive tests and G0480–G0483 for definitive testing, with 83992 included in the drug class reporting.

WA: Washington Medicaid permits billing only one of CPT 80305/80306/80307 per client per day and only one of HCPCS G0480–G0483 per client per day. Washington reimburses up to 24 presumptive and up to 12 definitive tests per client per year and does not cover multiple listed PLA and other codes (for example 0007U, 0011U, 0082U, 0328U, G0659, H0003, 0517U–0520U).

WI: Wisconsin is exempt from the annual 18-DOS limits except code H0003 which has an annual limit of 40. WI will reimburse CPT 80305 up to 5 tests/month with an annual benefit limit of 42 per calendar year.

Defined Terms

Definitions

Presumptive drug testingScreening tests to determine presence or absence of drugs or drug classes; results are reported as negative or positive; reported once per date of service per CPT guidance.

Definitive drug testingConfirmation tests (qualitative/quantitative) that identify specific drugs and metabolites, reported using CPT/HCPCS/PLA codes and subject to per-date and annual limits.

Specimen Validity TestingTesting to ensure a specimen has not been adulterated or substituted; considered part of presumptive/definitive test codes and not separately reimbursable when performed same date as drug testing.

Proprietary Laboratory Analysis (PLA) CodesCodes that describe proprietary clinical lab analyses (ADLTs/CDLTs) as defined under PAMA; may be reported for definitive testing but are subject to policy rules.

Drug ClassA group of drugs with the same chemical structure, mechanism of action, and/or use.

Policy Background and Scope

This policy defines daily and annual reimbursement rules for drug testing, including presumptive screening tests (CPT 80305, 80306, 80307, H0003) and definitive/confirmation testing (HCPCS G0480–G0483, G0659; CPT 80320–80377, 83992; and specified PLA codes). It also clarifies that specimen validity testing is considered part of those drug test codes and is not separately reimbursable when performed the same date of service.

Scope: The policy applies to providers billing UnitedHealthcare Community Plan and governs services billed on the CMS-1500 form and, when specified, on the UB04. It defines per-date limits (a maximum of one presumptive and one definitive drug test reimbursable per patient per date of service) and annual frequency limits (generally 18 dates of service per calendar year for presumptive and 18 per year for definitive testing, unless a state exception applies).