T50.994A — Poisoning by other drugs, medicaments and biological substances, undetermined, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
- 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.
Key Coverage Criteria
- 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.
- Cystatin C measurement is covered when performed on an adult (age >=18) patient with a creatinine-based eGFR of 45–59 ml/min/1.73 m2 and who does not have markers of kidney damage.
- Cystatin C measurement is covered when the medical record documents a clear rationale that creatinine-based eGFR estimates are thought to be inaccurate and that more accurate knowledge of GFR will affect clinical decision-making or the patient’s plan of care.
- Cystatin C measurement is covered for adult patients (age >=18) with creatinine-based eGFR 45–59 ml/min/1.73 m2 who do not have markers of kidney damage.
- Cystatin C measurement is covered when documentation shows creatinine-based GFR estimates are believed to be inaccurate and more accurate GFR knowledge will affect clinical decision making or the patient's plan of care.
12 Active Policies
L35434 — Oximetry Services
J12
A56645 — Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
J12
A57205 — Billing and Coding: Oximetry Services
J12
L35006 — Controlled Substance Monitoring and Drugs of Abuse Testing
J12
L34417
Related Codes
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