Does Z91.151 require prior authorization?

No, Z91.151 does not require prior authorization (high confidence). Covered without prior authorization.

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`Z91.151`, Patient's noncompliance with renal dialysis due to financial hardship

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

All documentation must be maintained in the patient medical record, be legible, include patient identification and the identity of the physician or non-physician practitioner responsible for care, and be available to the contractor upon request.
Medical record documentation maintained by the ordering/treating physician must indicate the medical necessity and clinical indication(s) that led to ordering the drug test and support the selected diagnosis and CPT/HCPCS code(s).
All tests must be ordered in writing by the treating provider and the order must specify all drugs/drug classes to be tested; the physician’s order must include the clinical indication/medical necessity.

If the performing provider is different from the ordering/referring physician, the performing provider must maintain hard copy documentation of lab results and copies of the ordering physician’s order for the drug test.

The submitted medical record should support the use of the selected diagnosis code(s) and the submitted CPT/HCPCS code should describe the service performed.

The clinician must document medical necessity and the rationale for each UDT (presumptive or definitive) ordered in the beneficiary's medical record, including why the test is required for that patient.

Key Coverage Criteria

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).
Presumptive (qualitative/IA) urine drug testing is covered when medically necessary to immediately determine the presence or absence of drugs or drug classes for immediate clinical management.
Definitive (quantitative/confirmation) UDT using GC-MS or LC-MS/MS is covered when clinically indicated to identify specific drugs, metabolites, synthetic/analog drugs, or when presumptive testing is inadequate for patient management.
Point-of-care testing (POCT) presumptive IA is covered when the clinician and beneficiary are co-located and immediate results are required for same-encounter management.

3 Active Policies

WPS-J5-L34645, Urine Drug Testing

A56915, Billing and Coding: Urine Drug Testing

WPS-J8-L34645, Urine Drug Testing

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Z91.151, Patient's noncompliance with renal dialysis due to financial hardship