The MO HealthNet Division (MHD) covers qualitative (presumptive) and semi-quantitative drug screening tests. These tests report what drug classes (e.g., tricyclic antidepressants, phenothiazines, amphetamines, benzodiazepines, barbiturates, cannabinoids, methadone, opiates) are present (qualitative) and may provide an estimate (semi-quantitative) of the concentration.
MHD only covers quantitative (definitive) or “confirmative” tests if there is a positive screen for the drug class to be quantified and if the physician has documented the medical necessity in the patient medical record.
Physician offices or clinics may bill for initial drug screens performed at the point of care or independent and/or hospital laboratories may bill for screenings they perform. Both providers cannot bill for the same date of service for the same participant.
The ordering physician has certain responsibilities:
- The ordering physician must coordinate the billing of the drug screen tests with the performing laboratory.
- The ordering physician must document medical necessity in the patient medical record when ordering quantification of a drug class or a confirmatory drug test.
- The ordering physician must sign each order for drug screening tests by signing a paper order, or by electronic signature that conforms with the requirements of 13 CSR 65-3.050. The requirements state that an electronic signature means a computer data compilation of any symbol or series of symbols executed, adopted, or authorized by an individual with the intent to be the legally binding equivalent of the individual’s handwritten signature. The use of biometrics does not constitute an electronic signature; however, biometrics may be used as part of electronic signature verification. A signature stamp does not constitute an electronic signature.
The performing laboratory has certain responsibilities:
- The performing laboratory must ensure the physician has provided documentation of medical necessity when requesting quantification of a drug class or a confirmatory drug test.
- The performing laboratory must not perform quantification of a drug class or a confirmatory drug test without documentation of medical necessity.