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AHCCCS DFSM Claims Clues - Urine Drug Testing for Substance Use Disorder Medical Necessity and Billing Guidelines
Arizona Medicaid - AHCCCS·AZ · Psychiatry, Pain Management, Family Medicine +1 more·Claims & Billing
Effective date
May 1, 2024
We identified it
Jun 17, 2026
Summary
AHCCCS (Arizona Medicaid) has implemented new medical necessity and billing guidelines for urine drug testing (UDT) for substance use disorders, with strict frequency limits based on patient abstinence periods and enhanced documentation requirements. The policy establishes maximum allowed presumptive and definitive UDT tests per rolling time periods and prohibits routine/blanket testing orders.
Action Required
By May 1, 2024: Providers billing AHCCCS must update UDT ordering protocols to comply with new frequency limits: maximum 3 presumptive UDTs per rolling 7 days (0-90 days abstinence) or 30 days (>90 days abstinence), and maximum 1 definitive UDT per rolling 7 days (0-30 days abstinence), 3 per 30 days (31-90 days), or 3 per 90 days (>90 days). Billing team must implement tracking system for rolling periods and ensure all UDT orders are individualized with documented medical necessity in patient records. Claims exceeding frequency limits will be denied.