New Jersey: Reimbursement changes to drug screening and testing

Effective April 1, 2021, we made changes to presumptive drug screening and definitive drug testing reimbursement and CPT^® codes for the UnitedHealthcare Community Plan of New Jersey.

CPT code and specimen validity testing changes

• Terminated CPT codes that are no longer reimbursable: 

• New CPT codes that are reimbursable: 

• Specimen validity testing not covered 

• Specimen validity testing is included in the following presumptive and definitive drug test codes: 

Other reimbursement changes

• Independent labs and clinics providing drug and alcohol services and/or billing for outpatient treatment programs:
  • May only bill 1 encounter per date of service (DOS)
  • May bill no more than 10 patient encounters every 30 days for presumptive drug screening
  • For a definitive drug test to be covered, there must be a presumptive drug service claim for the same date of service or within 7 days prior to the date of service. If there is no claim that meets these requirements, your claim for the definitive drug test will be denied. The definitive drug test does not have to be the same drug class tested in the presumptive test but must meet the criteria for definitive testing below.
• Definitive drug test claims for reimbursement will be denied if a presumptive drug test is found for the same provider, same beneficiary and same DOS
• Definitive drug tests billed to the NJFamilyCare/Medicaid program after a negative presumptive test result will not be covered. They are considered not medically necessary.
• Every 30 days, you may bill no more than 7 drug classes per DOS and no more than 2 patient encounters for definitive drug testing
• We will deny claims reimbursement to independent labs that bill outpatient treatment with the CPT codes in column 1 when they have the same DOS as CPT codes in column 3 below:

Unchanged CPT codes

As a reminder, the following CPT codes remain the same.

Learn more

To learn more about New Jersey policy and billing procedures for drug screening and testing, follow these steps:

• Go to Welcome to New Jersey Medicaid: Document Download 1 (njmmis.com)
• Select Choose volume and number. Then enter 31 and 11.
• Click Submit Request to bring up the article

CPT^® is a registered trademark of the American Medical Association

PCA-1-21-04152-C&S-News_01192022