These services enable pain management providers to monitor patient adherence to treatment, and can even be considered a form of liability insurance by discouraging opioid abuse, misuse, and diversion. In fact, high-complexity drug testing is now mandatory in Florida and Georgia due to increasing morbidity and mortality associated with the use of controlled prescription drugs.

When embarking on offering these services, providers should be mindful of frequency of implementation, as monthly testing may be construed as overutilization of services, Dr. Florete warned. To protect against this, he advised instituting quarterly monitoring and sending patient urine and saliva specimens to a reference laboratory for confirmation.


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The capital needed to purchase machinery, reagents, and a refrigerant unit to perform onsite drug testing, as well as to employ dedicated laboratory personnel and to obtain state accreditation can be significant— between $75,000 and $100,000, he estimated. However, the income generated from such services can be lucrative and expected to increase on an ongoing basis, with reimbursement for such services ranging from $120 to $500 per test depending on the third-party payer.

“High-complexity drug testing can be highly profitable, but avoid overutilization, as this is punishable by loss of accreditation by third-party payers and may initiate a Medicare/Medicaid audit,” Dr. Florete explained.

In comparison, two ancillary services that require relatively small capital investments to get up and running are physical therapy and medication dispensing.

Reimbursement for physical therapy services can be between $2000 and $3000 per patient for the entire course of treatment, which requires a licensed physical therapist, a part-time assistant, and an exercise room. Basic equipment includes a treatment table, treadmill, upright bicycles, free weights, and exercise mats. “Bringing in a licensed massage therapist may add value,” Dr. Florete advised.