Does T76.01XD require prior authorization?

No, T76.01XD does not require prior authorization (high confidence). Covered without prior authorization.

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`T76.01XD`, Adult neglect or abandonment, suspected, 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.
Claims must meet the reasonable and necessary requirements described in the related LCD (L35101); providers must retain medical record documentation supporting medical necessity per the LCD.
When billing for services that are not covered, the claim must include the appropriate modifier to indicate non-coverage status.

When a second provider bills a diagnostic interview for a beneficiary they are seeing for the first time, documentation should support that it is the provider's first encounter with the beneficiary.

All documentation must be maintained in the patient's medical record and must be legible with appropriate patient identification (e.g., full name, dates of service) on every page.

Medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

Key Coverage Criteria

Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.
CPT code 96105 is indicated for formal evaluation of aphasia using a standardized instrument (for example, the Boston Diagnostic Aphasia Examination).
HCPCS codes G0017 and G0018 are appropriate for services provided in non-facility places of service other than Office.
CPT codes 96132, 96133, 96136, 96137, 96138, and 96139 may be used for neuropsychological testing intended to diagnose or characterize neurocognitive effects of medical disorders that impinge directly or indirectly on the brain.
Neuropsychological testing is covered when testing is necessary as an aid in diagnosis and therapeutic planning and the medical record documents the necessity.
When additional time is necessary to integrate previously completed technician- or computer-administered tests, neuropsychological testing may include time spent integrating self-report questionnaires as part of the evaluation.

6 Active Policies

FIRST_COAST-L34520, Psychological and Neuropsychological Tests

A57780, Billing and Coding: Psychological and Neuropsychological Tests

NOVITAS-JH-L35101, Psychiatric Codes

NOVITAS-JL-L35101, Psychiatric Codes

A57130, Billing and Coding: Psychiatric Codes

A56612, Billing and Coding: CT of the Head

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T76.01XD, Adult neglect or abandonment, suspected, subsequent encounter