Starting February 1, 2021, Healthfirst now limits the reimbursement of drug testing. To find out the affected tests and the documentation procedure, keep reading!
Effective February 1, 2021, Healthfirst limits the reimbursement of drug testing as follows:
- Consistent with industry standards, NY State Medicaid Regulations, Centers for Medicare and Medicaid Services (CMS), and the American Society of Addiction Medicine (ASAM), Healthfirst limits the reimbursement of definitive (confirmatory) drug testing to a maximum of 14 drugs/drug classes per date of service.
- Presumptive testing and definitive drug testing should not exceed one (1) unit per date of service up to 18 units per year (12 months), submitted by any provider. Requests for more than this amount require prior approval.
- Medical records must substantiate that each test ordered will impact treatment and must acknowledge receipt and consideration of prior test results, along with appropriate intervention.
- Blanket orders (i.e., routine standing orders for all patients in a physician’s practice) are not considered reasonable and necessary, and therefore are not covered.
Source: https://www.hfproviders.org/documents/root/0055-21-Drug-Testing-Policy_FINAL-v3.pdf
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