Does R41.85 require prior authorization?

No, R41.85 does not require prior authorization (high confidence). Covered without prior authorization.

`R41.85`, Anosognosia

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For services that require a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
The claim must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the urine drug test was performed.
For diagnostic urine drug tests, report the test result if known; if the result is not known, report the symptoms that prompted the performance of the test.
This billing and coding guidance complements Local Coverage Determination L35724 and providers should follow LCD L35724 in conjunction with NCCI/OPPS rules when preparing claims.

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.
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).
Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.

CGS-J15-L34353, Outpatient Psychiatry and Psychology Services

J15

CGS-J15-L34046, Speech-Language Pathology

J15

CGS-J18-L34046, Speech-Language Pathology

J18

CGS-J18-L34353, Outpatient Psychiatry and Psychology Services

J18

A56915

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