Alcohol and Drug Testing Policy


Effective with dates of service on or after December 1, 2011, the South Carolina Department of Health and Human Services (SCDHHS) will implement limitations on Alcohol and Drug Screens.  For the complete policy and billing instructions, please see the Physician, Laboratories and Other Medical Professionals manual located at


The alcohol and drug screen policy has been updated to closely align with the 2011 Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) guidance.  SCDHHS will cover no more than twenty-five (25) drug screens for HCPCS code G0431 per Fiscal Year (FY).  If the patient exceeds twenty-five (25), the claim will be denied with edit code 713.  This means that the alcohol and drug screening maximum unit allowed for this FY has already been met.  


SCDHHS policy continues to be that alcohol and drug screenings, as with all laboratory tests, must be ordered by a qualified practitioner defined as a physician, nurse practitioner or physician assistant, and services must be medically necessary in order to diagnose and treat the patient.  Copies of the written order, treatment plan and medical necessity by the referring provider must be maintained in the patient’s chart and is subject to an audit by the Division of Program Integrity.  If a  standing order is utilized, it also must be written by a qualified practitioner, must be individualized for the specific patient and can not be extended for more than sixty (60) days.  Drug and Alcohol screenings for employment purposes or court ordered screens are not covered. 


This bulletin affects fee-for-service policy and applies to those recipients in this service option and the Medical Home Network (MHN).  Please contact the appropriate Managed Care Organization (MCO) for their current coverage policy. 


Your continued support of the South Carolina Healthy Connections Medicaid Program is appreciated.  Please refer any questions or concerns regarding this bulletin to the SCDHHS Physician Services Program Managers at 803-898-2660.




Anthony E. Keck


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