A substance whose chemical constituents are being identified and measured.

A blood protein produced in response to and counteracting a specific antigen. Antibodies combine chemically with substances that the body recognizes as alien, such as bacteria, viruses, and foreign substances in the blood.

A toxin or other foreign substance that induces an immune response in the body, especially the production of antibodies.

An investigative (analytic) procedure in laboratory medicine, pharmacology, environmental biology and molecular biology for qualitatively assessing or quantitatively measuring the presence, amount, or functional activity of a target entity (the analyte). The analyte can be a drug, a biochemical substance, or a cell in an organism or organic sample.

The amount of alcohol in the bloodstream; expressed as a percentage. Simplified, most states consider a driver impaired with a BAL of 0.08% – this is 8/100^th of a percent of their blood is comprised of alcohol. On average, the possibility of death occurs with concentrations of 0.40%–0.50% – just under ½ percent concentrations.

Any of a group of closely related compounds that include cannabinol and the active constituents of cannabis.  THC and CBD are two of the most commonly known Cannabinoids.

The target drug or metabolite used to establish the cut-off value for that specific assay. A standard, reference material, or substance used to standardize or calibrate an instrument or laboratory procedure.

In legal contexts, refers to the chronological documentation or paper trail that records the sequence of custody, control, transfer, analysis, and disposition of physical or electronic evidence.  Chain of Custody Forms (CCF) are used to track the entire process of implementing a drug test.

Waived tests include test systems cleared by the FDA for home use and those tests approved for waiver under the CLIA criteria. Although CLIA requires that waived tests must be simple and have a low risk for erroneous results, this does not mean that waived tests are completely error-proof. See our CLIA-Waived section for more details.

Current Procedural Terminology, or CPT is an expansive, important code set published and maintained by the American Medical Association (AMA). CPT codes are used to describe tests, surgeries, evaluations, and any other medical procedure performed by a healthcare provider on a patient. CPT codes are an integral part of the billing process. CPT codes tell the insurance payer what procedures the healthcare provider would like to be reimbursed for and are also used to track important health data and measure performance and efficiency. 

Beginning January 1, 2017, there are new presumptive (screen) toxicology CPT codes that will replace the existing AMA CPT and CMS HCPCS codes for presumptive drug testing. All AMA and CMS definitive drug testing codes remain unchanged at this time.

The following AMA CPT codes for presumptive drug testing are deleted:

• 80300
• 80301
• 80302
• 80303
• 80304

In addition, the following AMA CPT codes for specimen validity testing are deleted:

• 84311
• 83986
• 82570

CMS will also recognize the new AMA codes and delete the following G codes:

• G0477
• G0478
• G0479

Presumptive drug testing

CPT code: 80305

Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipstick, cups, cards, cartridges) includes sample validation when performed, per date of service (maps to 80300 or G0477).

CPT code: 80306

Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or procedures, (e.g., immunoassay) read by instrumented assisted direct optical observation (e.g., dipstick, cups, cards, cartridges) includes sample validation when performed, per date of service (maps to 80300 or G0478).

CPT code: 80307

Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or procedures, by instrument chemistry and analyzers (e.g., utilizing immunoassay [EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (e.g., GC, HPLC), and mass spectrometry either with or without chromatography, (DAT, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service (maps to 80301, 80302, 80303, 80304 and G0479). Most of our presumptive drug tests at Quest Diagnostics will fit the CPT code 80307.

When a positive result occurs but is caused by a substance other than what substances the test is known or expected to test for.

The minimum concentration of drugs or metabolites in urine to trigger a positive result measured in nanograms over mililiter (ng/mL).

Anyone designated in DOT regulations as a safety-sensitive employee is subject to DOT drug & alcohol testing. What follows is an overview of what jobs are defined as safety-sensitive functions subject to testing.

Aviation FAA

Flight crews, flight attendants, flight instructors, air traffic controllers at facilities not operated by the FAA or under contract to the U.S. military, aircraft dispatchers, aircraft maintenance or preventative maintenance personnel, ground security coordinators and aviation screeners. Direct or contract employees of 14 CFR Part 121 or 135 certificate holders, Section 91.147 operators and air traffic control facilities not operated by the FAA or under contract to the US Military. See FAA regulations at 14 CFR Part 120.

Commercial Motor Carriers FMCSA

Commercial Drivers License (CDL) holders who operate Commercial Motor Vehicles, 26,001 lbs. gvwr. or greater, or operate a vehicle that carries 16 passengers or more including the driver, or required to display a DOT placard in the transportation of hazardous material.1 1 In some instances, states allow waivers from this qualification, such as operators of fire trucks and some farm equipment. Check with your state department of motor vehicles for more information. See FMCSA regulation at 49 CFR Part 382.

Maritime USCG

An agency of the U.S. Department of Homeland Security. Crew members operating a commercial vessel. See USCG regulations at 46 CFR Parts 4 & 16.

Pipeline PHMSA

Operations, maintenance and emergency response. See PHMSA regulations at 49 CFR Part 199.

Railroad FRA

Hours of Service Act personnel, engine & train, signal service or train dispatchers. See FRA regulations at 49 CFR Part 219.

Transit FTA

Vehicle operators, controllers, mechanics and armed security. See FTA regulations at 49 CFR Part 655.

Links to these regulations can be found on-line at www.dot.gov/odapc.

Remember: The tasks you actually perform qualify you as a safety-sensitive employee, not your job title. Also, some employees, like managers and supervisors, may be qualified for these jobs but not currently performing them. Do they have to be tested as well? In most cases, yes…if that employee may be asked at a moment’s notice or in an emergency to perform a safety sensitive job. Be sure to check industry specific regulations for further clarification.

The metabolite  of ethanol which is formed in the body by glucuronidation following exposure to ethanol, usually from drinking alcoholic beverages.

When a test reads a negative result and should not be.

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Fentanyl is an Opioid used as a pain reliever available in many forms including, injection, transdermal patch, and sublingual lozenge. It is an extremely potent narcotic analgesic 100 times more potent than Morphine with rapid on set effects and a short lasting duration of effects. Fentanyl has gained popularity as a recreational drug and can be produced illegally at low costs, often being mixed with, or mimicking drugs like Oxycodone and Heroin, creating lethal doses. Fentanyl is currently a Scheduled II controlled substance in the United States.

Tests that can be used by Criminal Justice and Law Enforcement.

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A substance formed in or necessary for metabolism or metabolic processes allowing the body to break down what has been ingested.  Certain drug metabolites can simply be waste, while others are what actually causes the desired effects among drug users.  In some cases a drug’s metabolite can be detected in a person’s system longer than the parent drug, in which, testing for a drug metabolite such as EtG would be a better option for determaining alcohol use.

A Medical Review Officer (MRO) is a person who is a licensed physician and who is responsible for receiving and reviewing laboratory results generated by an employer’s drug testing program and evaluating medical explanations for certain drug test results.

A term used in pharmacology that represents substances derived from the natural plant opium. Three major psychoactive opiates are Morphine, Codeine, and Thebaine which are all naturally occurring alkaloids found in the opium poppy.  Opiates have been used for centuries as pain relievers and are now known for their high potential for abuse, due to their euphoric effects and addictive properties both mental and physical. Habitual users often suffer from extreme withdrawal symptoms after cessation.

Opioids, unlike opiates, are synthetic and semi-synthetic substances, but similar to opiates, in that they bind to the opioid receptors of the brain and produce similar euphoric effects.  Opioids include drugs such as, but not limited to, Oxycodone or OxyContin, Heroin, and Fentanyl. Like opiates, they share a high risk for abuse and can be lethal when not taken properly.

Over-the-Counter, or OTC, testing devices are tests that are sold comercially directly to the consumer. They can be purchased online or in stores and in  pharmacies. These tests usually come in packs of two and have been approved to be administered at home without a doctor’s or medical professional’s consent or supervision.

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