Does R40.2214 require prior authorization?

No, R40.2214 does not require prior authorization (high confidence). Covered without prior authorization.

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`R40.2214`, Coma scale, best verbal response, none, 24 hours or more after hospital admission

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each echocardiography service requires a formal written report with interpretation retained in the record and copies of image documentation (paper or electronic) available for review.
A complete study must include M-mode and/or 2D measurements of LV end-diastolic diameter, LV end-systolic diameter, LV wall thickness, left atrial diameter, aortic valve excursion, and a qualitative description of LV function, or valid substitutes such as LV volumes, ejection fraction, and mass.

Key Coverage Criteria

Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
Urine, blood, or oral fluid specimens may be used for drug testing, with urine preferred for broad screening of common drugs.
Medicare Part B will pay for drug screening services when all coverage criteria, limitations, and medical necessity requirements of LCD DL34645 are met.
Claims for drug screening services are payable under Medicare Part B only in these places of service: office (11), urgent care (20), independent clinic (49), federally qualified health center — freestanding (50), rural health clinic — freestanding (72), and independent laboratory (81).

20 Active Policies

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L35906, Somatosensory Testing

J18

CGS-J18-L36029, Urine Drug Testing

J18

WPS-J5-L34624, Somatosensory Testing

WPS-J5-L34645, Urine Drug Testing

A57597, Billing and Coding: Somatosensory Testing

A56915, Billing and Coding: Urine Drug Testing

A59416, Billing and Coding: Urine Drug Testing

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

NGS-J6-L39611, Urine Drug Testing

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

WPS-J8-L34645, Urine Drug Testing

WPS-J8-L34624, Somatosensory Testing

A57077, Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing

FIRST_COAST-L36393, Controlled Substance Monitoring and Drugs of Abuse Testing

FIRST_COAST-L33958, Somatosensory Testing

NOVITAS-JH-L35006, Controlled Substance Monitoring and Drugs of Abuse Testing

`R40.2214`, Coma scale, best verbal response, none, 24 hours or more after hospital admission

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

R40.2214, Coma scale, best verbal response, none, 24 hours or more after hospital admission

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`R40.2214`, Coma scale, best verbal response, none, 24 hours or more after hospital admission