Does Z87.891 require prior authorization?

No, Z87.891 does not require prior authorization (high confidence). Covered without prior authorization.

`Z87.891`, Personal history of nicotine dependence

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For services that require a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
The claim must include a valid ICD-10-CM diagnosis code that best describes 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, report the symptoms that prompted the performance of the test.
This billing and coding guidance complements Local Coverage Determination L35724 and providers should follow LCD L35724 in conjunction with NCCI/OPPS rules when preparing claims.

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).
When a referring/ordering physician is required by the service or LCD, the test is covered if the ordering/referring physician is documented and the order meets the Local Coverage Determination criteria.
Urine drug testing performed as a diagnostic test or for clinical monitoring when there is a documented medical indication and a valid ICD-10-CM diagnosis code that best describes the patient's condition.
ICD-10 codes listed as covered if selection criteria are met: F17.210 - F17.219 (Nicotine dependence, cigarettes), Z13.6 (Encounter for screening for cardiovascular disorders [abdominal aortic aneurysm (AAA)]), Z87.891 (Personal history of nicotine dependence).

WPS-J5-L34645, Urine Drug Testing

A56915, Billing and Coding: Urine Drug Testing

NGS-J6-L39611, Urine Drug Testing

A59416, Billing and Coding: Urine Drug Testing

WPS-J8-L34645, Urine Drug Testing

Ask Backwork about documentation requirements, denial risks, or coverage in your state.