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2025 CPT code 80362

Qualitative or quantitative analysis of one or two opioids and their analogs in a patient specimen.

Adhere to the CPT guidelines for definitive drug testing, including the specifications for definitive methods (GC-MS, LC-MS) and the reporting rules related to the number of analytes and metabolites.

Modifiers may apply depending on the circumstances of service.Consult the CPT manual and your payer's guidelines for appropriate modifier usage.

Medical necessity for 80362 is established based on clinical suspicion of opioid use, monitoring compliance with prescribed opioid regimens, evaluating suspected overdose, or investigating potential non-compliance in substance abuse treatment programs.Documentation should clearly justify the medical rationale for ordering the test.

The clinical responsibility lies with the ordering physician who interprets the results in the context of the patient's clinical presentation. The laboratory is responsible for accurate performance and reporting of the test.

IMPORTANT:80361 (Opiates, 1 or more), 80363 (Opioids and opiate analogs; three or four), 80364 (Opioids and opiate analogs; five or more) are alternative codes depending on the number of analytes tested.If the specific analyte is not listed in 80320-80373, consider unlisted definitive procedure codes 80375, 80376, or 80377.Therapeutic Drug Assays (80143-80203) or Chemistry (82009-84830) sections may contain relevant codes depending on the testing context.

In simple words: This lab test checks for one or two specific types of opioid pain medications or similar substances in a sample from your body (like blood or urine). It uses advanced techniques to accurately measure the amount present or simply detect if they are there.

This CPT code encompasses the qualitative or quantitative analysis of one or two opioids and their analogs (opiate derivatives) in a patient specimen using definitive methods.Definitive methods include techniques like gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-mass spectrometry (LC-MS), capable of distinguishing between structural isomers.The test may be qualitative (positive/negative), quantitative (amount measured), or a combination of both. Specimens may include urine, blood, or other suitable matrices.

Example 1: A patient presents to the emergency department with suspected opioid overdose.80362 is used to identify the specific opioid(s) involved and quantify their concentration to guide treatment., A patient is enrolled in a drug rehabilitation program.Periodic testing using 80362 is conducted to monitor compliance with their prescribed medication regimen and to detect any potential use of other non-prescribed opioids., A post-surgical patient reports persistent pain, and the physician suspects that the patient may be using additional, non-prescribed opioids.A blood test using 80362 is ordered to investigate this possibility.

* Physician's order specifying the test requested (80362).* Patient's demographics and medical history.* Specimen collection date and time.* Specimen type (e.g., urine, blood).* Complete laboratory report with qualitative or quantitative results, including identification of the specific opioid(s) and their concentrations (if applicable).* Method of analysis used.

** Always cross-reference with the most up-to-date CPT manual and payer guidelines for accurate billing and reimbursement.

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