26-080 Coverage for HCPCS Codes G0482 and G0483 Ends on April 1, 2026
Date: 01/26/26
High‑level definitive drug testing codes discontinued for Medi‑Cal plans
Effective April 1, 2026, HCPCS codes G0482 and G0483 will no longer be covered under the Medi‑Cal plan. An internal review determined that these high‑level definitive drug testing codes are not medically necessary. This change ensures alignment with appropriate use of definitive drug testing and supports medically necessary billing practices.
Definitive drug testing code table
Code | Description | Coverage status | Notes |
|---|---|---|---|
G0482 | Definitive drug testing, 15–21 drug classes (includes metabolites) | Not covered | Not medically necessary |
G0483 | Definitive drug testing, 22+ drug classes | Not covered | Not medically necessary |
G0480 | Definitive drug testing, | Covered | Prior authorization required |
G0481 | Definitive drug testing, | Covered | Prior authorization required |
Billing guidance: Use codes G0480 or G0481
Definitive testing above 14 drug classes is rarely medically necessary. For Medi‑Cal patients, physicians, practitioners and other providers should bill one of the following codes:
- G0480 – Definitive drug testing, 1–7 drug classes
- G0481 – Definitive drug testing, 8–14 drug classes
Prior authorization is required for both codes.
EPSDT claims guidance
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services do not have an exception process. If claims are submitted with G0482 or G0483 for:
- Patients under age 21 –
- Claims are reviewed by the medical director for medical necessity.
- Claims will be denied if not medically necessary.
- Patients ages 21 and older –
- Both codes are denied as non-covered benefits.
- A review for medical necessity will not occur.
What you need to do starting April 1, 2026
To avoid processing delays or denials for non-covered services:
- Submit G0480 or G0481 based on the number of drug classes required for definitive drug testing.
Resources
See medical policy HNCA.CP.MP.542, Testing for Drugs of Abuse, effective April 1, 2026, at Medical Policies.
Need help? Contact us
If you have questions regarding the information contained in this update, contact CalViva Health at
888-893-1569. Behavioral Health providers can call 844-966-0298.
This information applies to Physicians, Practitioners, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.