Does T40.492A require prior authorization?

No, T40.492A does not require prior authorization (high confidence). Covered without prior authorization.

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`T40.492A`, Poisoning by other synthetic narcotics, intentional self-harm, 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.

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).
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.
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.

20 Active Policies

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L36029, Urine Drug Testing

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

A56915, Billing and Coding: Urine Drug Testing

WPS-J5-L36402, Allergy Testing

A57473, Billing and Coding: Allergy Testing

WPS-J5-L34645, Urine Drug Testing

A59416, Billing and Coding: Urine Drug Testing

NGS-J6-L39611, Urine Drug Testing

WPS-J8-L36402, Allergy Testing

WPS-J8-L34645, Urine Drug Testing

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

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

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

NOVITAS-JH-L35434, Oximetry Services

NGS-JK-L39611, Urine Drug Testing

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

`T40.492A`, Poisoning by other synthetic narcotics, intentional self-harm, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T40.492A, Poisoning by other synthetic narcotics, intentional self-harm, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T40.492A`, Poisoning by other synthetic narcotics, intentional self-harm, initial encounter