Billing Beat

UHC – Drug Testing Policy Update – PTP Edits – Commercial,Community, and MA

November 9, 2023
Policy Title Effective Date Summary of Changes
Drug Testing Policy, Professional Informational
  • Effective October 1st, 2023, CMS issued replacement files for NCCI procedure-to-procedure (PTP) edits, withdrawing the edits between column 1 codes 80305, 80306, and 80307 for presumptive test(s) and column 2 codes G0480 – G0483 and G0659 for definitive test(s) that were implemented on July 1, 2023.
  • United Healthcare applied these NCCI PTP edits, which may have resulted in denials for affected tests after July 1, 2023. Claims impacted by these edits are currently being adjusted based on the CMS withdrawal announcement.
  • United Healthcare will continue to address presumptive and definitive test(s) in the drug testing policy, which is available for review at UHCprovider.com. No updates have been made to the drug testing policy as a result of CMS’ July 1, 2023, announcement regarding these edits or its subsequent withdrawal.

Source: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/rpub/UHC-COMM-RPUB-November-2023.pdf

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