Medicare Advantage: New Reimbursement Policy: Drug Screen Testing (Policy 19-001, effective 10/01/19)

Empire BlueCross BlueShield (Empire) Medicare Advantage allows reimbursement for presumptive and definitive drug screening services. In certain circumstances, Empire Medicare Advantage allows reimbursement for presumptive drug testing by instrumented chemistry analyzers and definitive drug screening services for the same member provided on the same day by a reference laboratory.

 

Definitive drug testing may be done to confirm the results of a negative presumptive test or to identify substances when there is no presumptive test available. Provider’s documentation and member’s medical records should reflect that the test was properly ordered and support that the order was based on the result of the presumptive test.

 

In the event a reference lab (POS = 81) performs both presumptive and definitive tests on the same date of service, records should reflect that the ordering/treating provider issued a subsequent order for definitive testing based on the results of the presumptive tests.

 

For additional information, refer to the Drug Screen Testing reimbursement policy at www.empireblue.com/medicareprovider.

 

EBSCRNU-0024-19 June 2019   

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