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ICD-10-CM T40.496D, Underdosing of other synthetic narcotics, subsequent encounter | No Prior Auth

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`T40.496D`, Underdosing of other synthetic narcotics, subsequent 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.

The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.

Documentation of medical necessity for testing must be maintained in the patient's medical record and must conform to the documentation requirements in LCD L36393.

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.
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.
Standard skin testing is the preferred method when allergy testing is necessary.

8 Active Policies

WPS-J5-L36402, Allergy Testing

J5

A57473, Billing and Coding: Allergy Testing

J5

WPS-J8-L36402, Allergy Testing

J8

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

J9

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

J9

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

JH

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

JL

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

JL

Related Codes

T39.092A(8 policies)T39.093A(8 policies)T39.091A(8 policies)T39.012A(8 policies)T39.013A(8 policies)T39.014A(8 policies)T39.011A(8 policies)T39.094A(8 policies)

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