T50.915A — Adverse effect of multiple unspecified drugs, medicaments and biological substances, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
Key Coverage Criteria
- Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
- Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
- 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).
20 Active Policies
L39611 — Urine Drug Testing
J06
A59416 — Billing and Coding: Urine Drug Testing
J06
L36393 — Controlled Substance Monitoring and Drugs of Abuse Testing
J09
A57077 — Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
J09
A56645
Related Codes
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