According to the American Academy of Pain Medicine, UDS must be ordered by the treating physician or Nonphysician provider (NPP). In your assessment of billing data and the medical record, you should see both scheduled and random testing.  The SAMHSA UDS Collection Guidelines also stipulate that standards must be established to ensure that the specimen tested is the patient's current sample and not altered. [iii]

Scheduled Point of Contact UDS testing (e.g., every 3 months at the office appointment) is typically NOT sufficient to provide the physician with an accurate assessment of the patient's prescription compliance, as it allows the non-compliant patient sufficient time to defeat the accuracy of UDS tests. [iv]   Most payers (commercial, state, and federal) have established policies concerning UDS coverage. Please refer to your respective policies and regulations. However, the following are typical expected and unexpected findings when looking at pain management and UDS:

Expected	Unexpected
The patient is under the care of a Board-Certified Pain Management provider/service;	Billing of both presumptive and definitive UDS testing on each date of service;
The billing of a presumptive (qualitative) UDS and/or definitive (quantitative) UDS at the initial point of care;	Billing of the same definitive UDS CPT codes every time
Billing of a minimum of four (4) UDS tests/12-month period	Billing of a large number of definitive test codes without support in the encounter note;
A presumptive test is the first method of choice when testing (Usually with CPT codes 80305, 80306, or 80307)	Billing of presumptive and/or definitive UDS testing at regular intervals without exception (i.e., every 3 months). UDS testing should also be random and not "just" Point of Contact testing during regular office visits.
Definitive testing is performed when presumptive results demonstrate abnormal or inconsistent findings, or the provider suspects the patient is not compliant with the prescription regimen.	No documentation of accuracy of specimen (Specific gravity, pH, Creatinine, specimen temperature, color, volume), no chain of custody documentation
The UDS results are documented in the patient's medical record, noted in a timely manner, and incorporated into the patient's treatment plan.	No incorporation of the UDS results in the patient's treatment regimen.

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