Does R40.1 require prior authorization?

No, R40.1 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R40.1` — Stupor

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medical necessity for each test must be documented in the patient's medical record as required by LCD L35006.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.

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.
IPF services are 'active treatment' when provided under an individualized treatment or diagnostic plan developed by a physician with appropriate other disciplines based on a thorough evaluation of the patient's strengths and disabilities.
Services expected to reasonably improve the patient's condition or services provided for the purpose of diagnosis qualify as active treatment.
Services supervised and periodically evaluated by a physician (including physician-directed prescriptions and oversight of non-physician therapists) qualify as active treatment.
Psychotherapy, drug therapy (including antidepressants or tranquilizers when other active-treatment elements are present), electroconvulsive therapy, occupational therapy, recreational therapy, and planned milieu therapy qualify as active treatment when expected to result in measurable improvement.

A56915 — Billing and Coding: Urine Drug Testing

J05

A57480 — Billing and Coding: Psychiatry and Psychology Services

J05

L34645 — Urine Drug Testing

J05

L34616 — Psychiatry and Psychology Services

J05

A56865 — Billing and Coding: Psychiatric Inpatient Hospitalization

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