Does R40.2A require prior authorization?

No, R40.2A does not require prior authorization (high confidence). Code is covered without prior authorization.

`R40.2A` — Nontraumatic coma due to underlying condition

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.
Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
Urine, blood, or oral fluid specimens may be used for drug testing, with urine preferred for broad screening of common drugs.

A56915 — Billing and Coding: Urine Drug Testing

J05

A57597 — Billing and Coding: Somatosensory Testing

J05

L34645 — Urine Drug Testing

J05

L34624 — Somatosensory Testing

J05

L39611 — Urine Drug Testing

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