Z91.198 — Patient's noncompliance with other medical treatment and regimen for other reason
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
- 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).
- Controlled substance monitoring and drugs-of-abuse testing are covered when individually ordered by the treating clinician and meet the reasonable and necessary requirements specified in LCD L36393.
- When a referring/ordering physician is required by the service or LCD, the test is covered if the ordering/referring physician is documented and the order meets the Local Coverage Determination criteria.
13 Active Policies
L39611 — Urine Drug Testing
J06
A59416 — Billing and Coding: Urine Drug Testing
J06
A57077 — Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
J09
L36393 — Controlled Substance Monitoring and Drugs of Abuse Testing
J09
L35006
Related Codes
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