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Urine Drug Testing Policy Effective Dec. 15, 2014

March 12, 2015

Blue Cross and Blue Shield of Oklahoma (BCBSOK) Medical Policy MED207.154 (Urine Drug Testing Including Pain Management and Substance Abuse Monitoring) became effective Dec. 15, 2014. This new policy addresses the overutilization of quantitative/confirmatory urine drug testing as a routine screening tool. With few exceptions, this policy prohibits the routine use of quantitative/confirmatory testing as being not medically necessary. The most prominent exception being when a patient tests positive on a qualitative test and the physician determines it is medically necessary for treatment decisions to know the quantity of the drug in the patient’s system.

BCBSOK encourages our providers to review this new policy as soon as possible to ensure they only submit claims that are consistent with this new policy. The BCBSOK Special Investigations Department will be monitoring provider compliance and may initiate investigations as appropriate. Independently contracted providers found billing inappropriately, contrary to this policy, may be subject to overpayment refunds and other actions as deemed appropriate based on the circumstances of each case.

View the Billing/Documentation Guidelines for Urine Drug Tests .

The BCBSOK Medical Policies are for informational purposes only and are not a replacement for the independent medical judgment of physicians. Physicians are encouraged to exercise their own clinical judgment based on each individual patient’s health care needs. Some benefit plans administered by BCBSOK, such as some self-funded employer plans or governmental plans, may not utilize BCBSOK Medical Policy. Members should contact their local customer services representative for specific coverage information.