Urine Drug Testing
L&I requires a baseline urine drug test (UDT) to verify the presence of prescribed opioids and the absence of non-prescribed drugs before considering opioid coverage beyond the acute phase of an injury.
For patients who meet WAC criteria for chronic opioid therapy, additional UDTs are required at a frequency determined by the patient’s risk category. A UDT should also be repeated at the time of service whenever a provider becomes aware of aberrant behavior, such as a report of lost prescriptions, concurrent opioid prescribing, or apparent intoxication.
Refer to Appendix D of the 2015 AMDG Interagency Guideline on Prescribing Opioids for Pain for additional clinical information.
Screening (aka point-of-care or presumptive) UDT – This type of test can yield immediate results and indicates whether a given drug is present or absent to verify a patient’s compliance and guide the prescribing of additional drug therapy. Screening UDTs may rarely give false positive or negative results, but if a test yields expected results, there is usually no need for a confirmatory UDT. The following are billing codes for screening UDTs, depending on the type of test used:
- 80305 – test of any number of drugs read by direct visual observation
- 80306 – test of any number of drugs read by instrument-aided visual observation
- 80307 – test of any number of drugs read by instrument chemistry analyzers (e.g., utilizing immunoassay, chromatography or mass spectrometry)
Screening UDTs are covered for patients being prescribed opioids during the acute phase after injury or surgery or whenever chronic opioid therapy is authorized.
Confirmatory (aka definitive or quantitative analysis) UDT – This type of test is performed by a laboratory and does not provide immediate results. Confirmatory UDTs can definitively tell whether a drug is present or absent, as well as the drug’s concentration. The provider should order a confirmatory UDT when a screening UDT yields an unexpected result. The following are billing codes for confirmatory UDTs, depending on the number of drugs tested:
- G0480 – 1-7 drugs
- G0481 – 8-14 drugs
- G0482 – 15-21 drugs
- G0483 – 22 or more drugs
Confirmatory UDTs require prior authorization. Coverage is based on whether the drug therapy being monitored is covered and whether there is clinical rationale to justify the need to verify a screening UDT result.