This NEW policy applies to 1199 SEIU Benefits Fund Members and outlines the reimbursement, covered and non-covered drug tests.
Under this new policy, 1199 SEIU Benefits Fund will pay for medically necessary toxicology testing services: when performed in a physician-supervised treatment setting. The 1199 SEIU Benefits Fund will cover Presumptive and Definitive toxicology testing.
Presumptive Drug Testing:
1199 SEIU Benefits Fund will cover 1 (ONE) unit per given DOS (date of service). The maximum number will NOT exceed 32 units per calendar year.
Definitive Drug Testing:
1199 SEIU Benefits Fund will cover 1 (ONE) unit per given DOS (date of service). The maximum number will NOT exceed 16 units per calendar year.
Prior Authorization:
Once the maximum number of test have been exhausted (presumptive or definitive) the other tests will NOT be covered, unless the provider requests an AUTHORIZATION. Providers can call Benefits Fund Prior Auth line: 646-473-6868.
The following codes are NOT COVERED AND WILL BE DENIED:
0006U, 0020U, 0007U, P2031, G4082, G0483
The following codes are included in the codes for the presumptive and definitive drug testing and WILL NOT BE reimbursed separately, when billed on the SAME DOS (date of service):
81000, 81001, 81003, 81005, 82570, 83986
Drug Tests ordered on BEHALF of a third party: schools, courts, etc; are NOT COVERED.
For more information about this NEW policy including more information about the two types of drug testing, please click here.
KR2 Medical Billing 