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Documentation Guidelines for Urine Drug Testing

Posted October 30, 2018

Blue Cross and Blue Shield of Illinois (BCBSIL) processes and reimburses claims for urine drug testing in accordance with BCBSIL Medical Policy MED207.154, Drug Testing in Pain Management and Substance Use Disorder Monitoring. BCBSIL only reimburses claims for urine drug testing that are medically necessary under that medical policy.

BCBSIL requires that urine drug testing claims are properly documented – documentation must reflect the medical necessity of the testing. The provider who submits the claim is responsible for submitting such documentation upon request. Incomplete or insufficient records may result in a denial of payment for services. 

Providers who order or perform drug testing should carefully review BCBSIL Medical Policy MED207.154.  Medical policies are updated regularly, so it is important to visit the Medical Policy section of our Provider website often for the most current information.

For more information on BCBSIL’s documentation and medical necessity requirements for urine drug testing claims, refer to the Documentation Guidelines for Urine Drug Testing.

For additional information related to HMO Illinois®, Blue Advantage HMOSM, Blue Precision HMOSM, BlueCare DirectSM and Blue FocusCareSM, refer to the BCBSIL HMO Provider Manual, located in the Standards and Requirements section of our Provider website.

The BCBSIL Medical Policies are for informational purposes only and are not a substitute for the independent medical judgment of health care providers. Providers are instructed to exercise their own clinical judgment based on each individual patient’s health care needs. The fact that a service or treatment is described in a medical policy is not a guarantee that the service or treatment is a covered benefit under a health benefit plan. Some benefit plans administered by BCBSIL, such as some self-funded employer plans or governmental plans, may not utilize BCBSIL Medical Policies. Members should contact the customer service number on their member ID card for more specific coverage information.