Urine Drug Testing (UDT) – effective January 1, 2020
Posted on November 18, 2019
Health New England understands urine drug testing is medically necessary and plays an integral role in effective medical management of opioids. It should also be used appropriately to inform clinical decision making.
Health New England reimburses for covered, medically necessary drug testing services as defined in our Clinical Review Criteria for Drug Testing guidelines available on healthnewengland.org. However, effective January 1, 2020, we will only reimburse:
- Up to 20 services for drug testing related to any diagnosis category per member per 365 days (emergency room, ambulatory surgery, and inpatient services are excluded).
- One unit of multi-drug screenings per day except when performed as a part of an emergency room visit, ambulatory surgery, or an inpatient admission.
When exceeding the 20 services limitation, a prior authorization is required before initiating the services. For more information, please refer to the Urine Drug Screening Testing Payment Policy found at healthnewengland.org/providers/resources – click into the Payment Policies section
