Does Z91.A20 require prior authorization?

No, Z91.A20 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z91.A20` — Caregiver's intentional underdosing of patient's medication regimen due to financial hardship

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.

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).
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.
Urine drug testing performed as a diagnostic test or for clinical monitoring when there is a documented medical indication and a valid ICD-10-CM diagnosis code that best describes the patient's condition.
Presumptive (qualitative/IA) urine drug testing is covered when medically necessary to immediately determine the presence or absence of drugs or drug classes to inform immediate clinical management.
Point-of-care testing (POCT) is covered when medically necessary and the clinician caring for the beneficiary and the beneficiary are in the same location and immediate results are required for patient management.

L39611 — Urine Drug Testing

J06

A59416 — Billing and Coding: Urine Drug Testing

J06

A56818 — Billing and Coding: Urine Drug Testing

L35724 — Urine Drug Testing

L36029 — Urine Drug Testing

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