Does T40.495D require prior authorization?

No, T40.495D does not require prior authorization (high confidence). Covered without prior authorization.

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`T40.495D`, Adverse effect of other synthetic narcotics, subsequent encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
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.

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.
RAST type tests are covered when medically necessary and supported by the related Local Coverage Determination (LCD) and current medical literature or standards of practice.
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.
Monitored Anesthesia Care (MAC) is medically necessary when the patient has one or more documented diagnoses listed as supporting medical necessity (e.g., F91.9, G97.81, T81.9XXA, T88.8XXA, F79) and the diagnosis is matched to the anesthesia/CPT/HCPCS procedure performed.
Use G9 anesthesia modifier to indicate need for MAC due to a history of severe or advanced cardiopulmonary disease when the proceduralist determines additional monitoring is required.

20 Active Policies

CGS-J15-L40325, Allergy Diagnostic Testing

J15

CGS-J18-L40325, Allergy Diagnostic Testing

J18

WPS-J5-L36402, Allergy Testing

A57473, Billing and Coding: Allergy Testing

NGS-J6-L33591, RAST Type Tests

A56844, Billing and Coding: RAST Type Tests

NGS-J6-L40329, Allergy Diagnostic Testing

WPS-J8-L36402, Allergy 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-L35049, Monitored Anesthesia Care

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

NGS-JK-L33591, RAST Type Tests

NGS-JK-L40329, Allergy Diagnostic Testing

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

NOVITAS-JL-L35049, Monitored Anesthesia Care

A57361, Billing and Coding: Monitored Anesthesia Care

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

A59186, Billing and Coding: Magnesium

A56612, Billing and Coding: CT of the Head

`T40.495D`, Adverse effect of other synthetic narcotics, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T40.495D, Adverse effect of other synthetic narcotics, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T40.495D`, Adverse effect of other synthetic narcotics, subsequent encounter