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BT202183: IHCP updates PA and billing requirements for urine drug testing, effective Oct. 15, 2021

Indiana Medicaid (IHCP)·IN · Pain Management, Psychiatry, Family Medicine +1 more·Pharmacy
Effective date
Oct 15, 2021
We identified it
Jun 19, 2026
Days to comply

Summary

Indiana Health Coverage Programs (IHCP) is changing urine drug testing billing codes effective October 15, 2021. CPT codes 80320-80377 for definitive UDT will no longer be reimbursed and must be replaced with G-codes (G0480-G0483, G0659). New prior authorization requirements apply for definitive testing with 15+ drug classes and testing beyond 16 units per member per year.

Action Required

Action needed
By October 15, 2021: Billing team must update billing system to stop using CPT codes 80320-80377 for definitive UDT and replace with G-codes (G0480-G0483, G0659). Configure prior authorization requirements for codes G0482 and G0483 (15+ drug classes) and for all definitive testing beyond 16 units per member per calendar year. Update encounter forms to reflect new coding requirements. Claims using old CPT codes will be denied after October 15, 2021.

Affected Billing Codes

80305
80306
80307
80320
80321
80322
80323
80324
80325
80326
80327
80328
80329
80330
80331
80332
80333
80334
80335
80336
80337
80338
80339
80340
80341
80342
80343
80344
80345
80346
80347
80348
80349
80350
80351
80352
80353
80354
80355
80356
80357
80358
80359
80360
80361
80362
80363
80364
80365
80366
80367
80368
80369
80370
80371
80372
80373
80374
80375
80376
80377
G0480
G0481
G0482
G0483
G0659