Does T40.413A require prior authorization?

No, T40.413A does not require prior authorization (high confidence). Covered without prior authorization.

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`T40.413A`, Poisoning by fentanyl or fentanyl analogs, assault, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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).
All tests must be ordered in writing by the treating provider and the order must specify all drugs/drug classes to be tested; the physician’s order must include the clinical indication/medical necessity.

If the performing provider is different from the ordering/referring physician, the performing provider must maintain hard copy documentation of lab results and copies of the ordering physician’s order for the drug test.

The submitted medical record should support the use of the selected diagnosis code(s) and the submitted CPT/HCPCS code should describe the service performed.

When E/M services are reported with allergy testing, medical documentation of the separately identifiable E/M service must be present in the medical record and modifier -25 must be used.

Key Coverage Criteria

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).
Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed.
Allergy testing includes performance, evaluation, and reading of cutaneous and mucous membrane tests together with physician history (including immunologic history), physical examination, antigen selection, and interpretation of results.
Standard skin testing is the preferred method when allergy testing is necessary.

6 Active Policies

WPS-J5-L34645, Urine Drug Testing

WPS-J5-L36402, Allergy Testing

A56915, Billing and Coding: Urine Drug Testing

A57473, Billing and Coding: Allergy Testing

WPS-J8-L34645, Urine Drug Testing

WPS-J8-L36402, Allergy Testing

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T40.413A, Poisoning by fentanyl or fentanyl analogs, assault, initial encounter