Does Blue Cross Blue Shield Cover Drug Tests?

Does Blue Cross Blue Shield cover drug tests? Yes, BCBS official documents state that Blue Cross Blue Shield covers presumptive and confirmatory drug tests.¹These tests are often used for:

• Detecting and diagnosing substance use disorder
• Monitoring recovery from substance use disorder (SUD)
• Supporting safe and effective opioid addiction treatment 
• Confirming the presence or absence of specific drugs in the system

ChoicePoint accepts BCBS insurance for prescreening, drug testing, and comprehensive addiction treatments. Call 844.445.2565 to schedule an appointment. 

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Highlights 

• Blue Cross Blue Shield covers both screening and confirmatory drug tests.
• The frequency of drug test coverage varies depending on the treatment phase.
• BCBS may not cover a drug test if it is not a medical necessity or a pre-employment drug test. 
• To know the exact coverage, it is best to verify insurance at a BCBS in-network rehab center such as ChoicePoint. 

What Type of Drug Tests Are Covered By Blue Cross Blue Shield?

Both screening and definitive urine drug tests are covered by Blue Cross Blue Shield.² Details include:

1. Presumptive Drug or Urine Tests For SUD

Presumptive drug tests are the first step in screening. These are often quick and can identify a wide range of drug categories, but they cannot always confirm exactly which drug was used or the amount.

Common drug categories detected by presumptive tests include: 2

• Amphetamines (methamphetamine, MDMA)
• Barbiturates
• Benzodiazepines
• Cocaine
• Marijuana (THC)
• Methadone
• Opiates (morphine, codeine)
• Oxycodone
• Phencyclidine (PCP)
• Synthetic cannabinoids and other emerging drugs (depending on test panel)

2. BCBS Coverage Guidelines for Presumptive Testing

Blue Cross Blue Shield may set limits on how often presumptive drug tests can be billed based on the patient’s stage of recovery. 

BCBS covers presumptive tests when:

• The test is needed for safe treatment or monitoring
• Testing frequency matches the patient’s recovery stage:
  a. Early recovery (0–90 days): 1 to 3 urine tests per week
  b. 31-90 days of absence: up to 3 times a week
  c. Greater than 90 days of consecutive absence: 1-3 urine tests per month.
• More frequent testing is allowed if a doctor explains why it is needed in the medical records

3. Confirmatory Drug Tests

These are more advanced, lab-based tests that give exact and highly accurate results. They are often done to double-check a presumptive test or to identify the exact drug and amount in the body.

BCBS Covered Levels OF Care

How Many Drug Test Are Covered by Blue Cross Blue Shield?

Blue Cross Blue Shield may cover: ³

• The test is ordered by a doctor
• Frequency is based on the recovery stage:
  • 0–30 days: once a week
  • 31–90 days: up to 3 times a month
  • Over 90 days: up to 3 times every 3 months
  • Extra testing is covered if there is a clear medical reason

Common drug categories detected by confirmatory tests include:

All categories from presumptive testing and other most addictive drugs:

• Specific opioids (e.g., fentanyl, tramadol)
• Specific benzodiazepines (e.g., alprazolam, lorazepam)
• Designer stimulants
• Hallucinogens (e.g., LSD)
• Prescription drugs that are not always picked up by screening tests
• Drug metabolites 

ChoicePoint offers at-home drug testing services and kits, saving you the inconvenience of visiting a rehab. Call 844.445.2565 to schedule an appointment!

Common Reasons Why Coverage For Drug Tests May Vary?

Health insurance coverage for drug tests varies by individual. The benefits you receive depend on several factors, including your insurance plan type, your state’s laws, and whether your coverage is linked to an employer-sponsored program.

1. Different Insurance Plans

1. BCBS offers different rehab coverage and plans in different states with different tiers. Gold plans may offer more coverage than bronze plans. 
2. The coverage also depends on whether you have met your deductibles and the premium you pay for your plan. 
3. Some private BCBS plans may only pay for drug tests if they are medically necessary. For example, BCBS of Texas ⁴ requires proper medical documentation, the correct test codes, and proof that the test is needed before paying for it. 

2. Different State Laws

Each BCBS plan is run locally, so state laws and policies can change what is covered. For example, BCBS NJ says state and federal laws, along with the details of your personal plan, will determine coverage. What is approved in one state may not be approved in another. ⁵

3. Employer Plans etc.

If your BCBS coverage comes from your employer, your drug testing benefits may be different from standard plans. Some employer plans, like the BCBS Federal Employee Program (FEP), include extra benefits that may affect coverage. 6 Employers in safety-sensitive jobs may also require certain drug tests, but not all plans may cover them under the health plan.

Does Horizon NJ/ BCBS Cover Drug Testing?

If you are a resident of New Jersey, Horizon NJ also covers drug tests.⁷ Coverage usually includes:

Covers drug tests when medically necessary, such as for pain management or substance use disorder treatment.

• Baseline: 1 test at the start of treatment.
• Stabilization phase: Up to 4 tests per month.
• Maintenance phase: Up to 4 tests per year.
• Confirmatory tests: Up to 3 every 30 days, only if the initial test is positive or further checking is needed.
• Hair and oral fluid tests may not be covered.
• Routine testing without a medical reason may not be covered.
• Correct billing codes and documentation are required for payment or reimbursement.

Scenarios Where BCBS May Not Cover Drug Tests

Drug tests may not be covered by BCBS if:

• They are not a medical necessity.
• Some plans do not consider employer drug tests as a medical necessity, so employment drug tests may not be covered.
• Third-party ordered drug tests may not be covered, e.g, court-ordered drug tests.

Call 844.445.2565 to speak to a customer representative to explore solutions for your scenario.

What Documents May I Need For Drug Test Coverage or Cash Reimbursement 

The reimbursement policy usually requires: ⁸

1. A written order or prescription from a licensed healthcare provider
2. Medical records showing the reason for the test (for example, addiction treatment or pain management)
3. Correct billing codes and CPT/HCPCS codes for the test performed
4. Laboratory report with test results and date of service
5. Proof of payment if requesting reimbursement (such as receipts or billing statements)
6. Insurance claim form if required by your BCBS plan
7. Any prior authorization approval, if your plan requires it, for drug testing

Let ChoicePoint Assist You With Drug Testing and Addiction Recovery

ChoicePoint is a BCBS in-network rehab. We offer:

• BCBS alcohol rehab
• BCBS-covered therapy
• BCBS EMDR therapy
• BCBS-covered outpatient programs
• BCBS-covered comprehensive substance abuse treatment 
• BCBS covered Sublocade treatment program
• BCBS vitirol injections 
• BCBS covered Suboxone and other MAT prescriptions.

As an in-network rehab, we assist our clients with pre-authorization, IOP authorization, medical necessity forms, and other relevant paperwork. You can also avail yourself of our BCBS therapists near you, online addiction treatment programs, at-home drug testing kits, or visit us in person at our NJ rehab to begin your healing journey. Call 844.445.2565 for confidential assistance.

CALL NOW FOR FREE SCREENING

FAQs Related To Blue Cross Blue Shield Drug Test Coverage 

Find answers to the most asked questions:

1. What is the Five-Pannel Drug Test?

A standard screening that checks for marijuana (THC), cocaine, amphetamines, opiates, and PCP. It is widely used for workplace and legal testing because it covers the most common substances of abuse.

2. What are the Three Main Stages of Drug Testing?

First, the sample is collected under controlled conditions. Next, an initial immunoassay screen is performed. Finally, any positive result is confirmed with advanced methods for accuracy.

3. What Do Pre-Employment Drug Tests Look For?

Most pre-employment tests focus on illicit drugs such as marijuana, cocaine, opiates, amphetamines, and PCP, although some employers request expanded panels to include prescription medications.

4. Does BCBS Require Preauthorization For Drug Tests?

Many BCBS plans require preauthorization, especially for frequent or specialized tests. Requirements vary by state and policy, so members should check their plan documents or contact customer service.

References 

1. Horizon Blue Cross Blue Shield of New Jersey. (n.d.). Reimbursement policies & guidelines: Urine drug screening & testing. Horizon Blue Cross Blue Shield of New Jersey. Retrieved from
   https://www.horizonblue.com/providers/policies-procedures/policies/reimbursement-policies-guidelines/urine-drug-screening-testing
2. Blue Cross Blue Shield of North Dakota. (n.d.). Drug testing (medical policy). Blue Cross Blue Shield of North Dakota. Retrieved from
   https://www.bcbsnd.com/providers/policies-precertification/medical-policy/d/drug-testing
3. Excellus BlueCross BlueShield. (n.d.). Urine drug testing (medical policy). Excellus BlueCross BlueShield. Retrieved from https://www.excellusbcbs.com/documents/d/global/exc-prv-urine-drug-testing
4. Blue Cross Blue Shield of Texas. (n.d.). Homepage. Blue Cross Blue Shield of Texas. Retrieved from https://www.bcbstx.com/
5. Blue Cross Blue Shield – Federal Employee Program. (n.d.). Home. FEP Blue. Retrieved from
   https://www.fepblue.org/
6. Horizon NJ Health. (n.d.-a). Reimbursement policies & guidelines: Urine drug testing. Horizon NJ Health. Retrieved from https://www.horizonnjhealth.com/for-providers/resources/policies/reimbursement-policies-guidelines/urine-drug-testing
7. Horizon NJ Health. (n.d.-b). Reimbursement policy: Urine drug testing (updates & announcements). Horizon NJ Health. Retrieved from
   https://www.horizonnjhealth.com/for-providers/news/updates-and-announcements/reimbursement-policy-urine-drug-testing