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ICD-10-CM T43.634A, Poisoning by methylphenidate, undetermined, initial encounter | No Prior Auth

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`T43.634A`, Poisoning by methylphenidate, undetermined, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

For services requiring a referring or ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
A claim submitted without a valid ICD-10-CM diagnosis code will be returned as an incomplete claim under Section 1833(e) of the Social Security Act.
The ICD-10-CM diagnosis code(s) reported must best describe the patient's condition for which the urine drug test was performed.

For diagnostic urine drug tests, report the test result if known; if the result is not known at claim time, report the symptoms that prompted performance of the test.

This coding guidance complements the Local Coverage Determination (LCD) for Urine Drug Testing; refer to the LCD for coverage-specific clinical indications.

Providers must refer to applicable NCCI and OPPS requirements prior to billing Medicare.

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.
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.

20 Active Policies

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J18-L36029, Urine Drug Testing

J18

WPS-J5-L34645, Urine Drug Testing

J5

WPS-J5-L36402, Allergy Testing

J5

A57473, Billing and Coding: Allergy Testing

J5

A56915, Billing and Coding: Urine Drug Testing

J5

A59416, Billing and Coding: Urine Drug Testing

J6

NGS-J6-L39611, Urine Drug Testing

J6

WPS-J8-L36402, Allergy Testing

J8

WPS-J8-L34645, Urine Drug Testing

J8

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

J9

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

J9

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

JH

NOVITAS-JH-L35434, Oximetry Services

JH

NGS-JK-L39611, Urine Drug Testing

JK

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

JL

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

JL

A57205, Billing and Coding: Oximetry Services

JL

NOVITAS-JL-L35434, Oximetry Services

JL

A55001, Billing and Coding: Urine Drug Testing

Related Codes

T39.093A(20 policies)T39.014A(20 policies)T39.091A(20 policies)T39.092A(20 policies)T39.012A(20 policies)T39.013A(20 policies)T39.011A(20 policies)T39.094A(20 policies)

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