Does T42.0X5D require prior authorization?

No, T42.0X5D does not require prior authorization (high confidence). Covered without prior authorization.

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`T42.0X5D`, Adverse effect of hydantoin derivatives, 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.
When a limited or follow-up echocardiogram is performed, document the targeted cardiac problem/region and bill using the appropriate CPT code (93308 or 93321).
If the study is a screening exam, document and bill with the appropriate screening ICD-10 code; document any abnormal findings and use the resulting diagnosis for subsequent billing when applicable.

Key Coverage Criteria

Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
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.
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.

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

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

NOVITAS-JH-L35049, Monitored Anesthesia Care

NGS-JK-L33591, RAST Type Tests

NGS-JK-L40329, Allergy Diagnostic Testing

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

A57361, Billing and Coding: Monitored Anesthesia Care

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

NOVITAS-JL-L35049, Monitored Anesthesia Care

A59186, Billing and Coding: Magnesium

A56625, Billing and Coding: Echocardiography

A57189, Billing and Coding: Serum Magnesium

A56612, Billing and Coding: CT of the Head

`T42.0X5D`, Adverse effect of hydantoin derivatives, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T42.0X5D, Adverse effect of hydantoin derivatives, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T42.0X5D`, Adverse effect of hydantoin derivatives, subsequent encounter