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ICD-10-CM T39.012A, Poisoning by aspirin, intentional self-harm, initial encounter | No Prior Auth

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`T39.012A`, Poisoning by aspirin, intentional self-harm, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.

The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.

All documentation must be maintained in the patient medical record, be legible, include patient identification and the identity of the physician or non-physician practitioner responsible for care, and be available to the contractor upon request.

Medical record documentation maintained by the ordering/treating physician must indicate the medical necessity and clinical indication(s) that led to ordering the drug test and support the selected diagnosis and CPT/HCPCS code(s).

Key Coverage Criteria

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).
Controlled substance monitoring and drugs-of-abuse testing are covered when individually ordered by the treating clinician and meet the reasonable and necessary requirements specified in LCD L36393.

20 Active Policies

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L36029, Urine Drug Testing

J18

A56915, Billing and Coding: Urine Drug Testing

J5

WPS-J5-L36402, Allergy Testing

J5

A57473, Billing and Coding: Allergy Testing

J5

WPS-J5-L34645, Urine Drug Testing

J5

A59416, Billing and Coding: Urine Drug Testing

J6

NGS-J6-L39611, Urine Drug Testing

J6

WPS-J8-L36402, Allergy Testing

J8

WPS-J8-L34645, Urine Drug Testing

J8

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

J9

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

J9

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

JH

NOVITAS-JH-L35434, Oximetry Services

JH

NGS-JK-L39611, Urine Drug Testing

JK

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

JL

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

JL

A57205, Billing and Coding: Oximetry Services

JL

Related Codes

T39.314A(20 policies)T40.0X1A(20 policies)T39.092A(20 policies)T39.091A(20 policies)T39.011A(20 policies)T39.093A(20 policies)T39.013A(20 policies)T40.0X2A(20 policies)

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