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.