G0659 Drug test def simple all clDrug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem), excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes
Status X: statutory exclusion, not paid under the PFS.
22 of 23 payer prior-auth lists that name G0659 require prior authorization or set conditions: Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Utah, Molina Healthcare of Wisconsin, Passport by Molina Healthcare (Kentucky).
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Complete Care (Virginia) | Medicare-only PA matrix for D-SNP | VA | prior auth under conditions | PA after 12 dates of service | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022 |
| Molina Complete Care (Virginia) | Virginia state exceptions to the national Medicaid grid (exceptions only) | VA | prior auth under conditions | State exception; PA after 12 dates of service | Apr 1, 2025 | Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 |
| Molina Complete Care (Virginia) | Medicaid | VA | prior auth under conditions | State exception; PA after 12 dates of service | Apr 1, 2025 | Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 |
| Molina Healthcare of Arizona | Medicare-only PA matrix for D-SNP | AZ | prior auth under conditions | PA after 12 dates of service | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022 |
| Molina Healthcare of California | Medicaid | CA | prior auth required | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 | |
| Molina Healthcare of Idaho | Medicaid | ID | prior auth required | Jan 1, 2025 | Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025 | |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth under conditions | PA after 12 dates of service | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 |
| Molina Healthcare of Michigan | Medicare Advantage | MI | prior auth under conditions | PA after 12 dates of service | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 |
| Molina Healthcare of Michigan | Medicaid | MI | prior auth under conditions | PA after 12 dates of service | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 |
| Molina Healthcare of Mississippi | Medicaid | MS | prior auth under conditions | PA after 12 dates of service | Jan 1, 2025 | Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025 |
| Molina Healthcare of Nevada | Medicaid | NV | prior auth under conditions | PA after 12 dates of service | Oct 1, 2022 | Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 |
| Molina Healthcare of New Mexico | Medicaid | NM | prior auth under conditions | PA after 12 dates of service | Jul 1, 2026 | New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026 |
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth under conditions | PA after 12 units | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
| Molina Healthcare of Ohio | Medicare and MyCare Ohio (MMP) Medicare | OH | prior auth under conditions | PA after 12 units | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
| Molina Healthcare of Ohio | Exchange | OH | prior auth under conditions | PA after 12 units | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
| Molina Healthcare of Texas | STAR | TX | prior auth required | Feb 19, 2025 | Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19 | |
| Molina Healthcare of Texas | STAR+PLUS | TX | prior auth required | Feb 19, 2025 | Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19 | |
| Molina Healthcare of Texas | STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix) | TX | prior auth under conditions | PA after 12 dates of service | Jul 1, 2023 | Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3 |
| Molina Healthcare of Texas | Exchange | TX | prior auth under conditions | PA after 12 units | Jan 1, 2021 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 |
| Molina Healthcare of Utah | Medicaid | UT | prior auth required | State exception | Jan 1, 2025 | Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025 |
| Molina Healthcare of Wisconsin | Medicare Advantage | WI | prior auth under conditions | PA after 12 dates of service | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021 |
| Passport by Molina Healthcare (Kentucky) | Medicaid | KY | prior auth required | Definitive urine drug testing is limited to 16 tests per calendar year (includes any… | Jul 1, 2026 | Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026 |
G0659 appears in 11 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Shield of California, BlueCross BlueShield of South Carolina, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Drug Testing in Pain Management and Substance Use Disorder Treatment (0965) | covered if criteria are met | Sep 1, 2026 | payer document |
| Anthem | Drug Testing or Screening in the Context of Substance Use Disorder and Chronic Pain (CG-LAB-09) | covered if criteria are met | Nov 6, 2025 | payer document |
| Blue Cross & Blue Shield of Mississippi | Urine Drug Testing | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Drug Testing sad MEDICAL COVERAGE POLICY | 4 | covered if criteria are met | Oct 1, 2025 | payer document |
| Blue Cross Blue Shield of Massachusetts | Drug Testing in Pain Management and Treatment of Substance Use Disorders (674) | listed, no stance | payer document | |
| Blue Shield of California | Drug Testing in Pain Management and Substance Use Disorder Treatment (2.04.98) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Prescription Medication and Illicit Drug Testing in the Outpatient Setting (CAM 140) Number | listed, no stance | Apr 1, 2026 | payer document |
| Centene | Drugs of Abuse: Definitive Testing (CP.MP.50) | covered if criteria are met | Jun 1, 2023 | payer document |
| Centene | Drugs of Abuse: Definitive Testing (CP.MP.50) | not covered | Jun 1, 2023 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Drug Testing in Pain Management and Substance Use Disorder Treatment (MED207.154) CPT Codes 80156, 80188, 80299, 80305, 80306, 80307, 80320, 80321, 80322, | listed, no stance | Jan 1, 2026 | payer document |
| Premera Blue Cross | Prescription Medication and Illicit Drug Testing in the Outpatient Setting | listed, no stance | Feb 6, 2026 | payer document |
| Regence | Drug Testing for Substance Use and Pain Management (Laboratory 68) | listed, no stance | Dec 1, 2025 | payer document |
Prior authorization required or conditional in WV.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.