Z91.A98 — Caregiver's noncompliance with patient's 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
- 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.
8 Active Policies
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
Related Codes
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