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MA06.025s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Act
by Jun 5, 2026
Effective date
Jun 5, 2026
Identified
Jun 19, 2026
Summary
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.
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What to do
by Jun 5, 2026 · 9 steps
01Billing team must update billing software to enforce the following rules.
02Do NOT reimburse CPT codes 80320-80331, 80345-80354, 80356-80365, 80367-80373, 80375-80377, and 83992 for Medicare Advantage members.
03Only reimburse presumptive drug testing using CPT 80305, 80306, or 80307.
04Only reimburse definitive drug testing using HCPCS codes G0480, G0481, G0482, G0483, or G0659.
05Implement maximum frequency limit of 24 dates of service per calendar year for all drug testing combined (regardless of test method, drug class, or combination testing).
06Add billing system logic to prevent reimbursement for same-date presumptive and definitive testing unless clinically justified.
07Configure system to flag and deny claims for medicolegal or employment-related drug testing as non-covered services.
08Update encounter templates and provider guidance documents.
09Providers should verify member plan type and capitated laboratory requirements (HMO/HMO-POS members must use PCP's designated capitated site, except New Jersey members with referral).
If missed: Failure to comply will result in claim denials and potential overpayments requiring recoupment.
Codes mentioned
80305803068030780320803218032280323803248032580326803278032880329803308033180345803468034780348803498035080351803528035380354803568035780358803598036080361803628036380364803658036780368803698037080371803728037380375803768037783992G0480G0481G0482G0483G0659
Original notice
MA06.025s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA06.025r, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management TreatmentsMediumEffective Oct 1, 2024 · PharmacyMA06.025s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management TreatmentsHighEffective Jun 5, 2026 · Pharmacy06.02.44r, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management TreatmentsMediumEffective Oct 1, 2024 · Pharmacy06.02.44s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management TreatmentsHighEffective Jun 5, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list
Related policy hubs
Independence Blue Cross policiesPain ManagementPsychiatryInternal MedicinePathologyCode 80305Code 80306Code 80307Code 80320Code 80321Code 80322Code 80323Code 80324Code 80325Code 80326Code 80327Code 80328Code 80329Code 80330Code 80331Code 80345Code 80346Code 80347Code 80348Code 80349Code 80350Code 80351Code 80352Code 80353Code 80354Code 80356Code 80357Code 80358Code 80359Code 80360Code 80361Code 80362Code 80363Code 80364Code 80365Code 80367Code 80368Code 80369Code 80370Code 80371Code 80372Code 80373Code 80375Code 80376Code 80377Code 83992Code G0480Code G0481Code G0482Code G0483Code G0659