Does T40.1X4A require prior authorization?

No, T40.1X4A does not require prior authorization (high confidence). Covered without prior authorization.

`T40.1X4A`, Poisoning by heroin, undetermined, initial encounter

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For services requiring a referring or ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
A claim submitted without a valid ICD-10-CM diagnosis code will be returned as an incomplete claim under Section 1833(e) of the Social Security Act.
The ICD-10-CM diagnosis code(s) reported must best describe 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 at claim time, report the symptoms that prompted performance of the test.

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.

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J18-L36029, Urine Drug Testing

J18

WPS-J5-L34645, Urine Drug Testing

WPS-J5-L36402, Allergy Testing

A57473, Billing and Coding: Allergy Testing

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