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Dear Provider,
Drug testing is an important clinical tool in the treatment of chronic pain and substance use disorders. Trends over the past several years indicate that increasingly these tests are not being ordered or performed in a patient-specific, evidence-based manner.
It is the responsibility of the ordering clinician to choose the specific, medically necessary test(s) for each patient based on current evidence and clinical guidelines.
Effective on or after 7/1/2018, Aetna Better Health® of Ohio will institute the following policy regarding drug testing:
When any provider or lab submits a claim for G0482 (definitive drug testing for 15 - 21 drug classes) or G0483 (definitive drug testing for more than 21 drug classes) for an outpatient place of service they must submit clinical records with the claim that substantiates the medical necessity of the test. Records must include a specific list of drug classes in question. Claims received without records will be denied for lack of documentation.
In the rare instances where these tests may be clinically indicated the medical record shall include a specific rationale, based on the patient's history and other relevant details, for the use of such expansive, definitive testing.
Please direct any questions you may have about this policy to our Provider Services department at 1-855-364-0974 or
[email protected].
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