What insurance policy changes affect CPT 80320?

There are 22 tracked policy changes affecting CPT 80320, including updates from Ambetter, Health Net, Arizona Medicaid - AHCCCS. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 80320?

Payers that have issued tracked updates for CPT 80320 include: Ambetter, Health Net, Arizona Medicaid - AHCCCS, Independence Blue Cross, Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, Colorado Medicaid, BCBS Arizona.

How do I get notified when CPT 80320 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 80320. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 80320?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

PAYER POLICY CHANGES

80320 Insurance Policy Changes

CPT 80320 is referenced in 22 tracked payer policy changes from Ambetter, Health Net, and 6 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 80320 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Ambetter · Effective Jan 1, 2027High impact
August Provider Newsletter
Ambetter of North Carolina will stop covering a list of HCPCS H codes starting January 1, 2027, and will cover H0006 from that date. Earlier changes are already effective: CPT 80320-80377 drug testing codes were no longer reimbursable from October 1, 2026, and the prior authorization changes effective October 1, 2026 took effect. The newsletter also covers surrogacy diagnosis codes Z33.3 and Z31.7, behavioral health type of bill guidance, and clinical policy updates effective 11/1/2026.
Ambetter · Effective Oct 1, 2026High impact
Update for CPT Codes 80320-80377: Effective 10/1/2026
Effective October 1, 2026, AmBetter Health will no longer reimburse CPT codes 80320–80377 (Definitive Drug Testing Procedures). Billing teams must stop submitting claims for these codes and instead bill the appropriate G-series bundled laboratory codes to avoid claim denials.
Ambetter · Effective Oct 1, 2026High impact
Update for CPT Codes 80320-80377: Effective 10/1/2026
Effective October 1, 2026, CPT codes 80320-80377 (Definitive Drug Testing Procedures) will no longer be reimbursable. Providers must transition to billing appropriate G-series bundled laboratory codes instead. This is a historical discovery of a policy that became effective on the analysis date.
Ambetter · Effective Oct 1, 2026High impact
Ambetter of Tennessee Q3 2026 Newsletter
Already effective October 1, 2026, prior authorization is removed for genetic testing codes 86812, 86813, and 86817, home visit codes S9211, S9213, and S9214, and medical transportation mileage code 38208, while sinus surgery code 31297 now requires prior authorization. CPT codes 80320 through 80377 for definitive drug testing are no longer reimbursable as of October 1, 2026. Effective December 5, 2026, Evolent will guide ordering providers to select a preferred site of care for shoulder, hip, knee, and spine surgeries, and effective January 1, 2027, Evolent will require prior authorization for listed cardiology and vascular procedure codes.
Ambetter · Effective Oct 1, 2026High impact
Update for CPT Codes 80320-80377: Effective 10/1/2026
Effective October 1, 2026, CPT codes 80320-80377 (Definitive Drug Testing Procedures) will no longer be reimbursable. Billing teams must transition to G-series bundled laboratory codes for all drug testing claims to avoid denials.
Ambetter · Effective Oct 1, 2026High impact
Ambetter Health Billing Code Update for CPT Codes 80320-80377 Effective 10/01/2026
Effective October 1, 2026, Ambetter Health will no longer reimburse CPT codes 80320-80377 (Definitive Drug Testing Procedures). Billing teams must transition to G-series bundled laboratory codes for these services to avoid claim denials.
Ambetter · Effective Oct 1, 2026High impact
Ambetter Health Billing Code Update for CPT Codes 80320-80377: Effective 10/01/2026
Effective October 1, 2026, Ambetter Health will no longer reimburse CPT codes 80320-80377 (Definitive Drug Testing Procedures). Billing teams must transition to G-series bundled laboratory codes for all drug testing claims to avoid denials.
Ambetter · Effective Oct 1, 2026High impact
Ambetter Health Billing Code Update for CPT Codes 80320-80377 Effective 10/01/2026
Effective October 1, 2026, Ambetter Health will no longer reimburse CPT codes 80320-80377 (Definitive Drug Testing Procedures). Providers must transition to billing G-series bundled laboratory codes instead to maintain reimbursement for these services.
Ambetter · Effective Oct 1, 2026High impact
Ambetter Health Billing Code Update for CPT Codes 80320-80377 Effective 10/01/2026
Effective October 1, 2026, Ambetter Health will no longer reimburse CPT codes 80320-80377 (Definitive Drug Testing Procedures). Providers must transition to G-series bundled laboratory codes for these services to maintain reimbursement.
Health Net · Effective Oct 1, 2026High impact
26-851 Definitive Drug Testing Billing Change, Effective October 1, 2026
Health Net will no longer reimburse CPT codes 80320-80377 for definitive drug testing effective October 1, 2026. Providers must transition to HCPCS G-series bundled laboratory codes (G0480-G0483) to avoid claim denials. All billing systems, charge masters, and workflows must be updated before the effective date.
Arizona Medicaid - AHCCCS · Effective Aug 24, 2026High impact
AHCCCS DFSM Claims Clues - August 2026
Already effective August 24, 2026, AHCCCS prepayment reviews claims for H2038 (skills training and development, per diem) billed without a group modifier, and supporting medical documentation must be submitted with the initial claim and every replacement claim. Already effective September 4, 2026, the Alivia analytics tool reviews NEMT trip tickets and a set of claim edits, and claims containing the listed errors will be denied. Already effective September 1, 2026, claims submitted by fee-for-service providers that include a referring, ordering, attending or prescribing provider who is not registered with AHCCCS will be denied.
Independence Blue Cross · Effective Jun 5, 2026High impact
MA06.025s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Independence Blue Cross updated MA06.025s to clarify reimbursement rules for presumptive and definitive drug testing when performed on the same date of service, and added new policy language for panel drug tests including proprietary tests. The policy reinforces that only CPT codes 80305, 80306, 80307 and HCPCS codes G0480, G0481, G0482, G0483, G0659 are covered for drug testing in substance abuse and pain management; CPT codes 80320-80331, 80345-80354, 80356-80365, 80367-80373, 80375-80377, and 83992 remain non-covered. Drug testing is limited to 24 dates of service per calendar year.
Independence Blue Cross · Effective Jun 5, 2026High impact
06.02.44s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Independence Blue Cross updated policy 06.02.44s to clarify that presumptive and definitive drug testing cannot both be reimbursed on the same date of service, and added guidance on coverage for panel drug tests including proprietary tests. Billing teams must ensure only appropriate codes (80305-80307 for presumptive; G0480-G0483, G0659 for definitive) are billed, never both on the same day, with a maximum of 24 dates of service per calendar year for covered members.
Independence Blue Cross · Effective Jun 5, 2026High impact
06.02.44s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Independence Blue Cross updated policy 06.02.44s to clarify reimbursement rules for presumptive and definitive drug testing on the same date of service and added coverage statements for panel drug tests. The policy covers presumptive testing (CPT 80305-80307) and definitive testing (HCPCS G0480-G0483, G0659) up to 24 dates of service per calendar year for pain management and substance abuse treatment, while non-covered definitive codes (CPT 80320-80331, 80345-80354, 80356-80365, 80367-80373, 80375-80377, 83992) remain excluded.
Excellus BlueCross BlueShield · Effective Oct 22, 2026Medium impact
Urine Drug Testing 2.02.50
Excellus BlueCross BlueShield policy 2.02.50 for urine drug testing considers in-office or point-of-care presumptive immunoassay urine drug testing medically appropriate for outpatient pain management and for outpatient substance use treatment, both for baseline screening and for ongoing monitoring at a frequency matched to the patient's risk. Definitive urine drug testing is considered medically appropriate when presumptive testing cannot identify a specific substance or drug, when a definitive drug concentration is needed to guide management, to rule out an error as the cause of a qualitative result, or as part of a differential assessment of medication efficacy, side effects, or drug-drug interactions. The October 22, 2026 version is recorded as an annual review with the policy intent unchanged.
Independence Blue Cross · Effective Jun 5, 2026Medium impact
MA06.025s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Independence Blue Cross Medicare Advantage is clarifying reimbursement rules for drug testing when presumptive and definitive tests are performed on the same date of service, and adding policy coverage for panel drug tests including proprietary tests. The policy specifies covered CPT codes (80305, 80306, 80307) for presumptive testing and HCPCS codes (G0480-G0483, G0659) for definitive testing, with a maximum of 24 dates of service per calendar year for drug testing regardless of method or combination.
Blue Cross & Blue Shield of Mississippi · Effective Jan 1, 2026Medium impact
Urine Drug Testing
Blue Cross Blue Shield Association policy 2.04.98 added CPT 0603U, a presumptive drug assay of 77 drugs or metabolites in urine by LC-MS/MS reported as positive or negative, which the code table lists as new as of 01/01/2026 and as investigational. The policy considers routine presumptive urine drug testing not medically necessary in chronic non-cancer pain management and substance use disorder treatment, and considers hair drug testing and oral fluid drug testing investigational in both settings. Presumptive urine drug testing is medically necessary only for the baseline screening and monitoring frequencies the policy lists for each setting.
Colorado Medicaid · Identified Jun 20, 2026Medium impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000444 - 02/2020)
Health First Colorado (Colorado's Medicaid Program) required prior authorization for a list of genetic testing codes effective February 10, 2020, and the Department said it intends to require prior authorization for all codes from 81170 through 81599 in phases. The bulletin also changed the Brain Injury Waiver Independent Living Skills Training benefit to a 15 minute unit effective February 1, 2020, and set billing rules for immediate post-partum LARC devices in DRG hospitals effective January 1, 2020.
Colorado Medicaid · Identified Jun 20, 2026Medium impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000450 - 07/2020)
Effective July 1, 2020, Health First Colorado applied a 1.0 percent across the board rate decrease to many service categories, with most rates subject to CMS approval before implementation, and HCBS waiver services reduced without CMS approval. The bulletin also said CPT codes 80320 through 80377 are anticipated to stop being billable for dates of service on or after September 1, 2020, to be replaced by HCPCS codes G0480 through G0483, and IntelliRide took over the NEMT benefit statewide effective July 1, 2020.
Colorado Medicaid · Identified Jun 20, 2026Medium impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100465 - 07/2021)
Health First Colorado's 2.5 percent across-the-board provider rate increases apply to dates of service starting July 1, 2021, once CMS approves them, and claims already paid at a lower rate are not adjusted for the higher rate. Effective July 1, 2021, cholesterol supplement products are billed with HCPCS B9998 and modifier U1, and HCPCS L8687 requires prior authorization. Definitive drug testing CPT codes 80320 through 80377 remained billable through July 31, 2021, and were replaced by HCPCS G0480 through G0483 starting August 1, 2021.
Colorado Medicaid · Identified Jun 20, 2026Medium impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100466 - 08/2021)
Relying solely on billing statements, member notification, or collection agencies is not effective, so providers must take appropriate and reasonable action to identify Health First Colorado eligibility within 365 days. Fee-for-service behavioral health codes were rebalanced to 80 to 100 percent of the Medicare benchmark effective April 1, 2021, and Medicaid prescribers of controlled substances must query the Colorado Prescription Drug Monitoring Program before prescribing to Medicaid members effective October 1, 2021, except in the listed situations. Physician-administered drugs on the listed set will require prior authorization no earlier than October 1, 2021.
BCBS Arizona · Identified Jun 16, 2026Medium impact
Drug Testing in Pain Management and Substance Abuse Disorders Treatment
Presumptive (immunoassay) urine drug testing in pain management is medically necessary with documentation of a baseline screening at treatment start or subsequent monitoring at a frequency matched to the individual's risk level, plus evidence the prescriber checked the state controlled substance abuse database at the start of each new course of treatment and at least quarterly. In substance use disorder treatment, presumptive testing is medically necessary at baseline (one time per program entry), targeted weekly for a maximum of 4 weeks in the stabilization phase, or once every 1 to 3 months in the maintenance phase, with the same database check, and definitive (confirmatory) urine drug testing is medically necessary only when immunoassays for the relevant drugs are not commercially available and definitive drug levels are required for clinical decision making. Hair testing and oral fluid drug testing are considered experimental or investigational in the treatment of pain management or substance use disorder(s) when any one of the five listed criteria is met.

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August Provider Newsletter

Update for CPT Codes 80320-80377: Effective 10/1/2026

Update for CPT Codes 80320-80377: Effective 10/1/2026

Ambetter of Tennessee Q3 2026 Newsletter

Update for CPT Codes 80320-80377: Effective 10/1/2026

Ambetter Health Billing Code Update for CPT Codes 80320-80377 Effective 10/01/2026

Ambetter Health Billing Code Update for CPT Codes 80320-80377: Effective 10/01/2026

Ambetter Health Billing Code Update for CPT Codes 80320-80377 Effective 10/01/2026

Ambetter Health Billing Code Update for CPT Codes 80320-80377 Effective 10/01/2026

26-851 Definitive Drug Testing Billing Change, Effective October 1, 2026

AHCCCS DFSM Claims Clues - August 2026

MA06.025s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments

06.02.44s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments

06.02.44s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments

Urine Drug Testing 2.02.50

MA06.025s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments

Urine Drug Testing

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000444 - 02/2020)

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000450 - 07/2020)

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100465 - 07/2021)

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100466 - 08/2021)

Drug Testing in Pain Management and Substance Abuse Disorders Treatment

What insurance policy changes affect CPT 80320?

Which payers have updated policy for CPT 80320?

How do I get notified when CPT 80320 policy changes?

Why do payers change policies for CPT 80320?