We usually follow Medicare Guidelines and our Policy is based on the LCD for UDT’s and we are having difficulty finding any guidance surrounding Oral Fluids as LCD L36393 only mentions Oral Fluid in a very general sense, everything is aimed directly at urine. There are no specific CPT or HCPCs codes mentioned as appropriate to be used for Oral Fluid testing or guidance.

We did locate 0011U-Prescription drug monitoring, evaluation of drugs present by LC-MS/MS, using oral fluid, reported as a comparison to an estimated steady-state range, per date of service including all drug compounds and metabolites. This is listed as a PLA code but I’m not entirely sure what would be required to verify that the lab performing this service is properly set up to perform this service.

Any help would be greatly appreciated.