Back to Insights and Updates for ProvidersDecember 2023

Urine Drug Testing Payment Policy integration

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial  |  Tufts Health Unify

Point32Health has developed an integrated Urine Drug Testing Payment Policy, which will replace the existing Harvard Pilgrim and Tufts Health Plan policies effective for dates of service beginning Feb. 1, 2024.

As of the effective date of the integrated policy, we’re implementing a number of coding and reimbursement changes as part of our continued effort to align policies and edits where possible for a streamlined Point32Health provider experience.

Definitive drug testing code changes

As of date of service Feb. 1, 2024, Tufts Health Plan commercial, Tufts Health Unify, and Tufts Health Direct will no longer reimburse definitive drug testing when billed with CPT codes 80320-80377 or 83992. Providers should report definitive drug testing using G0480-G0483 or G0659. This change in billing requirements is considered industry standard billing and supported by guidance from MassHealth and the Centers for Medicare and Medicaid Services.

Timeframe for standing orders

In alignment with current Tufts Health Plan requirements,30-day standing orders will no longer be accepted for drug tests for Harvard Pilgrim commercial members. An individual order will be required for each date of service.

Annual limits for urine drug testing update

Currently, Tufts Health Plan commercial products and Tufts Health Direct allow 20 presumptive tests (any combination) and 10 definitive tests to billed within a 365-day period. As of date of service Feb. 1, 2024, this coverage will be updated to align with Harvard Pilgrim’s policy of allowing a maximum of 20 urine drug tests (definitive or presumptive) per calendar year to be reimbursed.

For complete information, please refer to the Point32Health Urine Drug Testing Payment Policy (Harvard Pilgrim, Tufts Health Plan).

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