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AHCCCS DFSM Claims Clues - Urine Drug Testing memo
Arizona Medicaid - AHCCCS·AZ · Psychiatry, Pain Management, Family Medicine +1 more·Claims & Billing
Effective date
Aug 1, 2024
We identified it
Jun 17, 2026
Summary
AHCCCS (Arizona Medicaid) has implemented new medical necessity guidelines and frequency limits for urine drug testing in substance use disorder treatment, effective August 1, 2024. The policy establishes maximum allowed presumptive UDTs (3 per 7 days for early recovery, 3 per 30 days for >90 days abstinence) and requires specific clinical documentation to support medical necessity for both presumptive and definitive testing.
Action Required
Immediately: Billing team must update systems to enforce AHCCCS UDT frequency limits - maximum 3 presumptive UDTs per 7 days for patients with 0-90 days abstinence, maximum 3 per 30 days for patients with >90 days abstinence. Providers must document individual medical necessity for each UDT order including clinical history, risk assessment, and how results will guide treatment decisions. Stop billing simultaneous presumptive and definitive tests for same substances, reflex testing without physician orders, and routine blanket UDT orders. Claims exceeding frequency limits or lacking proper documentation will be denied.