One specimen. A presumptive answer. The Urine Drug Screen Only (also called UDS only, urine drug screen without reflex, or presumptive urine drug screen) tests urine for a defined set of drug classes on instrumented chemistry analyzers and reports the screen without automatic confirmation. Requesting physicians order it to monitor patient medications when a presumptive result is what the clinical question needs.
At a glance
| Detail | Information |
|---|---|
| Test name | Urine Drug Screen Only (Medication Monitoring) |
| Also known as | UDS only; urine drug screen without reflex; presumptive urine drug screen |
| Category | Toxicology |
| Methodology | Presumptive drug testing by instrumented chemistry analyzers |
| Specimen | Urine |
| CPT | 80301, 80302, 80304, 80320 |
| Ordered by | Requesting physicians monitoring patient medications |
What it detects
The panel screens for the following drugs and drug classes. THC and Ethanol/EtG can be removed at ordering, and EtS/G can be removed separately.
| Group | Targets |
|---|---|
| Opioids | Opiates, Oxycodone, Methadone, Buprenorphine |
| Stimulants | Amphetamines, Methamphetamine, Cocaine, MDMA |
| Sedatives | Benzodiazepines, Barbiturates |
| Other drugs | Phencyclidine, TCA |
| Cannabis | THC (can be removed) |
| Alcohol | Ethanol/EtG (EtS/G can be removed) |
EtG and EtS are direct ethanol metabolites. In urine they extend the detection window beyond breath or blood ethanol, to up to 80 hours. The TLS EtG cutoff is 50 ng/mL, against a 200 ng/mL industry standard.
When to order it
Order the UDS only when you are monitoring medications and a presumptive result answers the question in front of you.
- Routine medication monitoring. Check adherence and look for unexpected substances in patients on controlled substances. Objective data also supports documentation for regulatory and payer requirements.
- Baseline testing. Establish a clinical starting point before ongoing care.
- Alcohol abstinence monitoring. EtG/EtS is the most clinically useful biomarker for monitoring abstinence and detecting episodic drinking, including in patients on naltrexone, disulfiram or acamprosate.
- Point-of-care follow-up. The TLS requisition lets you record your in-office POC results (POS or NEG) for 14 analytes. You choose whether to reflex positive POC results or confirm prescribed negative POC results.
The requisition offers two paths: Urine Drug Screen w/Reflex, or Urine Drug Screen Only. You can also add individual tests, each with SCREEN and CONFIRM options. If the result will drive a decision on dose, discharge or discontinuation, plan for confirmation. The TLS definitive menu is by LC/MS and covers named parent drugs and metabolites across opioids, benzodiazepines, stimulants, sedatives and more.
For related guidance, see Pain Management Toxicology Testing: A Provider’s Guide.
Specimen collection
The specimen is urine. The documents available for this page do not specify container type, minimum volume or handling and storage requirements. For collection instructions, contact the lab before you collect.
Complete the requisition fully. It requires patient and primary insurance subscriber information, along with ICD-10 diagnosis codes (enter only those that apply). The pre-printed options are Z79.891, Z79.899 and F11.20.
Understanding the report
The sample TLS toxicology report lists each analyte under Drugs of Abuse Screen with these columns:
- Test name
- Result
- Units
- Flag
- Reference range/cutoff
Each analyte is flagged Positive or Negative. Positives are highlighted in red, so a flagged result is visible at a glance. On the sample report, cutoffs and units appear as follows:
| Analyte | Cutoff |
|---|---|
| Amphetamines | <100 ng/mL |
| Barbiturates | <200 ng/mL |
| Benzodiazepines | <200 ng/mL |
| Opiates | <300 ng/mL |
| Cannabinoids (THC) | <50 ng/mL |
| Cocaine | <300 ng/mL |
| Heroin metabolite (6-AM) | <10 ng/mL |
| Phencyclidine (PCP) | <25 ng/mL |
| Ethanol | <50.0 mg/dL |
The sample report also includes a line chart of a patient’s historical results across collection dates, so trends sit next to the current result. A "Detailed Definitive Results" section follows the screen when definitive testing is ordered.
Why order it from Total Lab Solutions
- Flexible ordering. Remove THC, remove EtS/G, or add individual screen and confirm tests on the same requisition.
- Validity testing on every specimen. It is performed by default. The requisition has a box to opt out. The validity tests on the TLS CPT list are pH, specific gravity and creatinine.
- A sensitive alcohol cutoff. The TLS EtG cutoff is 50 ng/mL, 4× more sensitive than the 200 ng/mL industry standard. EtS serves as a confirmatory pair to rule out false-positive EtG from hand sanitizer or mouthwash exposure.
- A path to confirmation. If a presumptive result needs confirming, definitive LC/MS testing is on the same order form.
Browse the full testing panel.
Frequently asked questions
What is a urine drug screen only (UDS without reflex) and how does it differ from a UDS with reflex to confirmation testing?
The UDS only is a presumptive screen run on instrumented chemistry analyzers. The TLS requisition lists "Urine Drug Screen w/Reflex" and "Urine Drug Screen Only" as alternative selections. The reflex option carries the screen forward to confirmation. The screen-only option reports the presumptive result. You can still add individual confirm tests when you order.
When is a presumptive urine drug screen alone appropriate for medication monitoring, and when should I order definitive LC-MS/MS confirmation?
A presumptive screen alone fits routine monitoring where a qualitative positive or negative answers the question. Order confirmation when the result will drive a consequential decision, or when you need to identify a specific parent drug or metabolite. The TLS definitive menu is by LC/MS and covers named analytes such as Oxycodone/Noroxycodone, Fentanyl/Norfentanyl and Alprazolam/A-hydroxyalprazolam. On the requisition, each individually selectable analyte has a CONFIRM option.
Which drug classes and medications are included on the urine drug screen only panel, and what are the cutoff concentrations?
The panel covers amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine, MDMA, methadone, methamphetamine, opiates, oxycodone, phencyclidine, TCA, THC (removable) and Ethanol/EtG (EtS/G removable). Cutoffs for the analytes shown on the sample report are in the table above. The TLS EtG cutoff is 50 ng/mL. Cutoffs for buprenorphine, MDMA, methadone, methamphetamine, oxycodone and TCA are not stated in the documents available here. Confirm them with the lab before relying on them.
How should presumptive immunoassay results be interpreted given the risk of false positives and false negatives, and what specimen validity checks are performed?
Treat a screen as presumptive and correlate it with the clinical picture and the patient’s medication list. For alcohol, EtS cross-checks EtG to rule out false positives from hand sanitizer or mouthwash. EtG can be degraded by urinary bacteria, while EtS is more stable. Cross-reactivity details for the other analytes are not in the documents available for this page. For specimen validity, testing is performed on all specimens unless you opt out on the requisition. The validity tests on the TLS CPT list are pH, specific gravity and creatinine.
What are the specimen collection requirements, turnaround time, and billing or medical necessity considerations for ordering a urine drug screen only?
The specimen is urine. Container, volume and handling details, and turnaround time, are not specified in the documents available here. Contact the lab for both. For billing, the CPT codes for this test are 80301, 80302, 80304 and 80320. The requisition requires ICD-10 diagnosis codes (enter only those that apply) and complete payer information: payer name, group number and policy number.
Order the screen, add confirmation where the decision demands it, and let the report carry the trend.
