Does R40.2413 require prior authorization?

No, R40.2413 does not require prior authorization (high confidence). Covered without prior authorization.

`R40.2413`, Glasgow coma scale score 13-15, at hospital admission

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
Medical necessity for each test must be documented in the patient's medical record as required by LCD L35006.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.

Urine drug testing (UDT) and drugs-of-abuse testing are covered when reasonable and necessary per LCD L35006 and ordered on an individual patient basis by the treating clinician with medical-record documentation of medical necessity.
Patients with a documented diagnosis consistent with substance use disorder (SUD) may qualify for an exception to the standard presumptive UDT annual limits.
Coverage indications for somatosensory testing follow the Local Coverage Determination L34433; this article provides billing and coding guidance only.
Presumptive (qualitative) urine drug testing (UDT) is covered when medically necessary to determine presence or absence of drugs or drug classes and when immediate results are needed (point-of-care testing when patient and clinician are co-located).
Definitive quantitative confirmation testing (GC-MS or LC-MS/MS) is covered when medically necessary to identify specific drugs or metabolites not adequately detected by presumptive testing, to distinguish specific drugs within a large drug family, or when a definitive concentration is needed to guide management.
Reflex definitive testing by a reference laboratory is covered without an additional clinician order to verify a presumptive positive UDT or to confirm the absence of a prescribed medication when a laboratory presumptive test is negative.

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

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

A56645, Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing

A56612, Billing and Coding: CT of the Head

A56769

Ask Backwork about documentation requirements, denial risks, or coverage in your state.