This Medical Policy is provided for informational purposes only.

If Members have any questions about the medical necessity of a service or procedure, they should discuss the question with their Network Provider or call a member of our Customer Service Team.

MEDICAL POLICY USE DISCLAIMER

  1. Medical Policy is used by Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company ("BCBSMS") as one set of guidelines (among other sets of guidelines) to assist BCBSMS in making benefit coverage decisions. BCBSMS utilizes Medical Policy adopted by our Medical Policy Advisory Committee ("MPAC") which is supported by the Blue Cross and Blue Shield Association Medical Policy, research and development. Medical Policies are the property of BCBSMS and any use of Medical Policy not agreed to by BCBSMS is strictly prohibited. The use of Medical Policy for purposes related to the health care of a BCBSMS plan member is permitted and is not a violation of the proprietary rights of BCBSMS.
  2. These Medical Policies are based on scientifically meritorious evidence provided through research for a particular medical technology. Medical Policy is also based on data from peer-reviewed scientific literature, from criteria developed by specialty societies and from guidelines adopted by other health care organizations.
  3. These Medical Policies apply to members/subscribers who have health insurance through BCBSMS. This Medical Policy also applies to Members of a self-insured group health plan for which Blue Cross & Blue Shield of Mississippi provides claims administration and persons covered by a Medicare Supplement policy offered by BCBSMS. This Medical Policy does not apply to any other individuals. Medical Policies may differ for Federal employees covered under the Federal Employees Health Benefits Plan.
  4. In the event of any conflict between this Medical Policy and any benefit plan, Summary Plan Description or other coverage document, the benefit plan, Summary Plan Description or other coverage document will govern.
  5. Medical technology is rapidly changing and these Medical Policies are subject to change without notice. Also, please be aware that as a result of ongoing changes being made to Medical Policy, BCBSMS cannot and does not guarantee that these Medical Policies are current.

BCBSMS Medical Policies are Subject to the Following Restrictions


This Medical Policy is provided for informational purposes only.

If Members have any questions about the medical necessity of a service or procedure, they should discuss the question with their Network Provider or call a member of our Customer Service Team.

MEDICAL POLICY USE DISCLAIMER

  1. Medical Policy is used by Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company ("BCBSMS") as one set of guidelines (among other sets of guidelines) to assist BCBSMS in making benefit coverage decisions. BCBSMS utilizes Medical Policy adopted by our Medical Policy Advisory Committee ("MPAC") which is supported by the Blue Cross and Blue Shield Association Medical Policy, research and development. Medical Policies are the property of BCBSMS and any use of Medical Policy not agreed to by BCBSMS is strictly prohibited. The use of Medical Policy for purposes related to the health care of a BCBSMS plan member is permitted and is not a violation of the proprietary rights of BCBSMS.
  2. These Medical Policies are based on scientifically meritorious evidence provided through research for a particular medical technology. Medical Policy is also based on data from peer-reviewed scientific literature, from criteria developed by specialty societies and from guidelines adopted by other health care organizations.
  3. These Medical Policies apply to members/subscribers who have health insurance through BCBSMS. This Medical Policy also applies to members of a self-insured group health plan for which Blue Cross & Blue Shield of Mississippi provides claims administration and persons covered by a Medicare Supplement policy offered by BCBSMS. This Medical Policy does not apply to any other individuals. Medical Policies may differ for Federal employees covered under the Federal Employees Health Benefits Plan.
  4. In the event of any conflict between this Medical Policy and any benefit plan, Summary Plan Description or other coverage document, the benefit plan, Summary Plan Description or other coverage document will govern.
  5. Medical technology is rapidly changing and these Medical Policies are subject to change without notice. Also, please be aware that as a result of ongoing changes being made to Medical Policy, BCBSMS cannot and does not guarantee that these Medical Policies are current.

BCBSMS Medical Policies are Subject to the Following Restrictions


This Medical Policy is provided for informational purposes only.

If Members have any questions about the medical necessity of a service or procedure, they should discuss the question with their Network Provider or call a member of our Customer Service Team.

MEDICAL POLICY USE DISCLAIMER

  1. Medical Policy is used by Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company ("BCBSMS") as one set of guidelines (among other sets of guidelines) to assist BCBSMS in making benefit coverage decisions. BCBSMS utilizes Medical Policy adopted by our Medical Policy Advisory Committee ("MPAC") which is supported by the Blue Cross and Blue Shield Association Medical Policy, research and development. Medical Policies are the property of BCBSMS and any use of Medical Policy not agreed to by BCBSMS is strictly prohibited. The use of Medical Policy for purposes related to the health care of a BCBSMS plan member is permitted and is not a violation of the proprietary rights of BCBSMS.
  2. These Medical Policies are based on scientifically meritorious evidence provided through research for a particular medical technology. Medical Policy is also based on data from peer-reviewed scientific literature, from criteria developed by specialty societies and from guidelines adopted by other health care organizations.
  3. These Medical Policies apply to members/subscribers who have health insurance through BCBSMS. This Medical Policy also applies to members of a self-insured group health plan for which Blue Cross & Blue Shield of Mississippi provides claims administration and persons covered by a Medicare Supplement policy offered by BCBSMS. This Medical Policy does not apply to any other individuals. Medical Policies may differ for Federal employees covered under the Federal Employees Health Benefits Plan.
  4. In the event of any conflict between this Medical Policy and any benefit plan, Summary Plan Description or other coverage document, the benefit plan, Summary Plan Description or other coverage document will govern.
  5. Medical technology is rapidly changing and these Medical Policies are subject to change without notice. Also, please be aware that as a result of ongoing changes being made to Medical Policy, BCBSMS cannot and does not guarantee that these Medical Policies are current.

BCBSMS Medical Policies are Subject to the Following Restrictions

Medical Policy Search
Printer Friendly Version Urine Drug Testing in Chronic Pain

Urine Drug Testing in Chronic Pain

 

DESCRIPTION

This policy addresses urine drug testing in patients with chronic non-cancer pain who are on chronic opioid therapy. Chronic non-cancer pain is pain in which the causes cannot be removed or otherwise treated and no relief or cure has been found after reasonable efforts. Chronic opioid therapy is daily or near-daily doses of opioid medication. Compliance monitoring has been shown to be crucial in delivering proper opioid therapy and preserving this therapy for the future.

Urine drug testing (UDT) is a widely available and familiar method for monitoring opioid use in chronic pain patients. UDT can provide tools for tracking patient compliance and expose possible drug misuse and abuse. UDT is one of the major tools of adherence monitoring in the assessment of the patient’s predisposition to, and patterns of,  misuse/abuse – a vital first step towards establishing and maintaining the safe and effective use of opioid analgesics in the treatment of chronic pain.

Frequency of Testing

A practical approach to UDT would include baseline drug testing, if appropriate; initiation of opioid therapy, and compliance monitoring within one to 3 months after baseline monitoring; and routine, random monitoring approximately every 6-12 months.  Thus, the majority of patients will receive a baseline test, initiation of the compliance test, and one year monitoring within the first 15 months or so. After that, if the patient is continuing with a pain management program, testing will only be required once a year.

Types of Urine Drug Tests

Two types of urine drug screens are typically used, immunoassay and gas chromatography–mass spectrometry. Several factors need to be considered to determine the length of time a drug or substance can be detected in the urine, including:

  • pharmacokinetics
  • presence of metabolites
  • patient variability (eg, body mass)
  • short-term vs. long-term use of a drug
  • pH of the urine
  • time of last ingestion

 

POLICY

One (1) baseline urine drug test is considered medically necessary to determine if a patient has been exposed to opioids and other controlled substances prior to initiating chronic opioid therapy.

Urine drug testing for monitoring opioid use in patients with chronic non-cancer pain may be considered medically necessary up to two (2) times per year, unless there are inconsistencies (abnormalities) in the urine drug test results. 

A confirmatory urine drug test is considered medically necessary only when there were inconsistencies (abnormalities) in the urine drug test results. 

 

POLICY EXCEPTIONS

None

 

POLICY GUIDELINES

Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

 

POLICY HISTORY

07/21/2012:  Approved by Medical Policy Advisory Committee.

 

SOURCE(S)

Pain Management Advisory Committee

Urine Drug Testing In Chronic Pain: Comprehensive Review, Paul J. Christo, MD1, Laxmaiah Manchikanti, MD2, Xiulu Ruan, MD3, Michael Bottros, MD1, Hans Hansen, MD4, Daneshvari R. Solanki, MD5, Arthur E. Jordan, MD6, and James Colson, MD7 Pain Physician 2011; 14:123-143 • ISSN 1533-3159 http://www.painphysicianjournal.com/2011/march/2011;14;123-143.pdf

Urine Drug Screening: A Practical Guide for Clinicians Karen E. Moeller, Kelly C. Lee, Julie C. Kissack, Mayo Clinic Proceedings, 2008 83(1): pp 66–76
http://www.mayoclinicproceedings.org/article/S0025-6196(11)61120-8/fulltext

Chronic Opioid Therapy (COT) Safety Guideline For Patients With Chronic Non-Cancer Pain, Copyright 2010–2012 Group Health Cooperative
http://www.ghc.org/all-sites/guidelines/chronicOpioid.pdf

 

CODE REFERENCE

Covered Codes

This may not not be a comprehensive list of procedure codes applicable to this policy.

The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.

Code Number

Description

CPT-4

80100

Drug screen, qualitative; multiple drug classes chromatographic method, each procedure

80101 

Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class 

80102

Drug confirmation, each procedure

80104 

Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure

ICD-9 Procedure

 

 

ICD-9 Diagnosis

V58.69   

Long-term (current) use of other medications 

HCPCS

G0431 

Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter

G0434 

Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter 

 

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