Does R44.2 require prior authorization?

No, R44.2 does not require prior authorization (high confidence). Covered without prior authorization.

`R44.2`, Other hallucinations

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.

Regional or local nerve blocks performed as an adjunct to, or as the sole means of, regional/local anesthesia for an operative procedure are not affected by this noncoverage policy (i.e., such intraoperative regional/local anesthesia is allowed).
Patient has a DSM-5 mental disorder diagnosis that is the reason for the ordering physician's treatment or for which the patient was hospitalized.
Drug testing services are covered when they meet the medical necessity and coverage indications specified in LCD L36029.
Medicare Part B will pay for drug screening services when furnished in allowed places of service: office (11), urgent care (20), independent clinic (49), FQHC freestanding (50), RHC freestanding (72), and independent laboratory (81).
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.

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J18-L36029, Urine Drug Testing

J18

A56915, Billing and Coding: Urine Drug Testing

WPS-J5-L34645, Urine Drug Testing

A59416, Billing and Coding: Urine Drug Testing

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