Does T42.73XA require prior authorization?

No, T42.73XA does not require prior authorization (high confidence). Code is covered without prior authorization.

`T42.73XA` — Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, assault, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Each claim must be submitted with ICD-10-CM code(s) that accurately reflect the patient’s condition and indicate the reason(s) the service was performed.
The medical record must include the ordering/referring provider’s name and NPI for services that require a referring/ordering physician.
The patient’s medical record should include the assessment by the ordering provider related to the patient’s complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports.
For diagnostic tests, report the test result on the claim when known; otherwise report the symptoms that prompted performance of the test.

Cardiac catheterization and coronary angiography are covered when the medical record documents medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests that support the procedure.
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.
Drug testing services are covered when they meet the medical necessity and coverage indications specified in LCD L36029.
Medicare Part B will pay for drug screening services when furnished in allowed places of service: office (11), urgent care (20), independent clinic (49), FQHC freestanding (50), RHC freestanding (72), and independent laboratory (81).
Urine, blood, or oral fluid specimens may be used for drug testing, with urine preferred for broad screening of common drugs.

A57472 — Billing and Coding: Allergy Immunotherapy

J05

A56915 — Billing and Coding: Urine Drug Testing

J05

A57473 — Billing and Coding: Allergy Testing

J05

L34645 — Urine Drug Testing

J05

L36408 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

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