All PlansCoverageHigh impact
Drug Testing for Substance Use and Pain Management
Regence BlueShield·Pain Management, Family Medicine, Internal Medicine +1 more·Pharmacy
Effective date
Apr 1, 2026
We identified it
Jun 16, 2026
Summary
New policy establishes strict limits on urine drug testing for pain management and substance use treatment. Only specific CPT codes are covered, limited to 15 tests per year for both presumptive and definitive testing, with one unit per date of service.
Action Required
Before April 1, 2026: Billing team must update system to limit drug testing codes 80305, 80306, 80307, G0480, G0481, G0659 to maximum 15 units per rolling year per patient. Configure edits to prevent billing multiple presumptive or definitive codes on same date. Block billing of non-covered codes 0082U, 0328U, 0587U, G0482, G0483. Update encounter forms to remind providers of annual limits. Claims exceeding limits will be denied as not medically necessary.