Urine drug testing/screening, when conducted for medical purposes related to the evaluation of patients being treated with controlled substances for non-cancer-related chronic pain, is covered only as described below. These requirements do not apply when urine drug testing/screening is performed:

• as part of an emergency room or urgent care center visit;
• during an observation or inpatient hospital stay;

Drug testing is defined as either presumptive (qualitative) or definitive (quantitative). A presumptive test confirms if a substance (analyte) is present in the specimen. A definitive test measures how much (the quantity) of an analyte is present.

Presumptive (qualitative) testing

For presumptive drug testing, Aetna allows one encounter per day up to eight (8) encounters per 12 month period. These are applicable codes for the presumptive drug tests:

80305       80306      80307

Definitive (quantitative) testing

Definitive testing is only covered if the presumptive testing indicates a positive result for the drug. Aetna allows one encounter per day up to eight (8) encounters per 12 month period. These are the applicable codes for the definitive drug tests:

G0480      G0481     G0482     G0483     0051U    0054U     G0659

If you have any questions about this policy, please contact us at 1-800-410-7778, 24 hours a day, 7 days a week, except major holidays.

01/2021