SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Urine Drug Testing

A56818

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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To see the currently-in-effect version of this document, go to the section.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56818
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Urine Drug Testing
Article Type
Billing and Coding
Original Effective Date
08/08/2019
Revision Effective Date
10/15/2023
Revision Ending Date
11/15/2023
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1.2 - A/B MAC (B) Contacts with Independent Clinical Laboratories

 

Article Guidance

Article Text

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD L36029 Urine Drug Testing.

A qualitative/presumptive drug screen is used to detect the presence of a drug in the body. A blood, urine, or oral fluid sample may be used. However, urine is the best specimen for broad screening, as blood is relatively insensitive for many common drugs, including psychotropic agents, opioids, and stimulants.

Common methods of drug analysis include chromatography, immunoassay, chemical ("spot") tests, and spectrometry.

 

Coding Guidelines

One presumptive drug testing code may be billed once per patient per day as indicated by the code description and should only be billed at one unit regardless of the provider.

 

One definitive drug testing code may be billed once per patient per day as indicated by the code description and should only be billed at one unit regardless of the provider.

The documentation should support the medical necessity of the drug testing ordered and should support the clinical indicators that led to ordering the test.

Documentation Requirements

  1. All documentation must be maintained in the patient’s medical record and available to the contractor upon request.
  1. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The record must include the identity of the physician or non-physician practitioner responsible for and providing the care to the patient.
  2. The submitted medical record should support the use of the selected diagnosis code(s). The submitted CPT/HCPCS code should describe the service performed.
  3. Medical record documentation (e.g., history and physical, progress notes) maintained by the ordering physician/treating physician must indicate the medical necessity for performing a drug test. All tests must be ordered in writing by the treating provider and all drugs/drug classes to be tested must be indicated in the order.
  1. If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of the lab results, along with copies of the ordering/referring physician’s order for the drug test. The physician must include the clinical indication/medical necessity in the order for the drug test.

This LCD does not apply to acute inpatient claims.

Claims for drug screening services are payable under Medicare Part B in the following places of service: office (11), urgent care (20), independent clinic (49), federally qualified health center (freestanding) (50), rural health clinic (freestanding) (72), and independent laboratory (81).

All services/procedures performed on the same day for the same beneficiary by the physician/provider should be billed on the same claim.

All coverage criteria must be met before Medicare can reimburse this service.

Billing for these services in a non-covered situation (e.g., does not meet indications of the LCD) will generally require an Advance Beneficiary Notice (ABN) be obtained before the service is rendered.

Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item, or procedure may not be covered by Medicare.

The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category, or is rendered for screening purposes.

 

Response To Comments

Number Comment Response
1
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Coding Information

Bill Type Codes

Code Description
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Revenue Codes

Code Description
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CPT/HCPCS Codes

Group 1

(8 Codes)
Group 1 Paragraph

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Group 1 Codes
Code Description
80305 DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE OF BEING READ BY DIRECT OPTICAL OBSERVATION ONLY (EG, UTILIZING IMMUNOASSAY [EG, DIPSTICKS, CUPS, CARDS, OR CARTRIDGES]), INCLUDES SAMPLE VALIDATION WHEN PERFORMED, PER DATE OF SERVICE
80306 DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; READ BY INSTRUMENT ASSISTED DIRECT OPTICAL OBSERVATION (EG, UTILIZING IMMUNOASSAY [EG, DIPSTICKS, CUPS, CARDS, OR CARTRIDGES]), INCLUDES SAMPLE VALIDATION WHEN PERFORMED, PER DATE OF SERVICE
80307 DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTRUMENT CHEMISTRY ANALYZERS (EG, UTILIZING IMMUNOASSAY [EG, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), CHROMATOGRAPHY (EG, GC, HPLC), AND MASS SPECTROMETRY EITHER WITH OR WITHOUT CHROMATOGRAPHY, (EG, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) INCLUDES SAMPLE VALIDATION WHEN PERFORMED, PER DATE OF SERVICE
G0480 DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT LIMITED TO GC/MS (ANY TYPE, SINGLE OR TANDEM) AND LC/MS (ANY TYPE, SINGLE OR TANDEM AND EXCLUDING IMMUNOASSAYS (E.G., IA, EIA, ELISA, EMIT, FPIA) AND ENZYMATIC METHODS (E.G., ALCOHOL DEHYDROGENASE)), (2) STABLE ISOTOPE OR OTHER UNIVERSALLY RECOGNIZED INTERNAL STANDARDS IN ALL SAMPLES (E.G., TO CONTROL FOR MATRIX EFFECTS, INTERFERENCES AND VARIATIONS IN SIGNAL STRENGTH), AND (3) METHOD OR DRUG-SPECIFIC CALIBRATION AND MATRIX-MATCHED QUALITY CONTROL MATERIAL (E.G., TO CONTROL FOR INSTRUMENT VARIATIONS AND MASS SPECTRAL DRIFT); QUALITATIVE OR QUANTITATIVE, ALL SOURCES, INCLUDES SPECIMEN VALIDITY TESTING, PER DAY; 1-7 DRUG CLASS(ES), INCLUDING METABOLITE(S) IF PERFORMED
G0481 DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT LIMITED TO GC/MS (ANY TYPE, SINGLE OR TANDEM) AND LC/MS (ANY TYPE, SINGLE OR TANDEM AND EXCLUDING IMMUNOASSAYS (E.G., IA, EIA, ELISA, EMIT, FPIA) AND ENZYMATIC METHODS (E.G., ALCOHOL DEHYDROGENASE)), (2) STABLE ISOTOPE OR OTHER UNIVERSALLY RECOGNIZED INTERNAL STANDARDS IN ALL SAMPLES (E.G., TO CONTROL FOR MATRIX EFFECTS, INTERFERENCES AND VARIATIONS IN SIGNAL STRENGTH), AND (3) METHOD OR DRUG-SPECIFIC CALIBRATION AND MATRIX-MATCHED QUALITY CONTROL MATERIAL (E.G., TO CONTROL FOR INSTRUMENT VARIATIONS AND MASS SPECTRAL DRIFT); QUALITATIVE OR QUANTITATIVE, ALL SOURCES, INCLUDES SPECIMEN VALIDITY TESTING, PER DAY; 8-14 DRUG CLASS(ES), INCLUDING METABOLITE(S) IF PERFORMED
G0482 DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT LIMITED TO GC/MS (ANY TYPE, SINGLE OR TANDEM) AND LC/MS (ANY TYPE, SINGLE OR TANDEM AND EXCLUDING IMMUNOASSAYS (E.G., IA, EIA, ELISA, EMIT, FPIA) AND ENZYMATIC METHODS (E.G., ALCOHOL DEHYDROGENASE)), (2) STABLE ISOTOPE OR OTHER UNIVERSALLY RECOGNIZED INTERNAL STANDARDS IN ALL SAMPLES (E.G., TO CONTROL FOR MATRIX EFFECTS, INTERFERENCES AND VARIATIONS IN SIGNAL STRENGTH), AND (3) METHOD OR DRUG-SPECIFIC CALIBRATION AND MATRIX-MATCHED QUALITY CONTROL MATERIAL (E.G., TO CONTROL FOR INSTRUMENT VARIATIONS AND MASS SPECTRAL DRIFT); QUALITATIVE OR QUANTITATIVE, ALL SOURCES, INCLUDES SPECIMEN VALIDITY TESTING, PER DAY; 15-21 DRUG CLASS(ES), INCLUDING METABOLITE(S) IF PERFORMED
G0483 DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT LIMITED TO GC/MS (ANY TYPE, SINGLE OR TANDEM) AND LC/MS (ANY TYPE, SINGLE OR TANDEM AND EXCLUDING IMMUNOASSAYS (E.G., IA, EIA, ELISA, EMIT, FPIA) AND ENZYMATIC METHODS (E.G., ALCOHOL DEHYDROGENASE)), (2) STABLE ISOTOPE OR OTHER UNIVERSALLY RECOGNIZED INTERNAL STANDARDS IN ALL SAMPLES (E.G., TO CONTROL FOR MATRIX EFFECTS, INTERFERENCES AND VARIATIONS IN SIGNAL STRENGTH), AND (3) METHOD OR DRUG-SPECIFIC CALIBRATION AND MATRIX-MATCHED QUALITY CONTROL MATERIAL (E.G., TO CONTROL FOR INSTRUMENT VARIATIONS AND MASS SPECTRAL DRIFT); QUALITATIVE OR QUANTITATIVE, ALL SOURCES, INCLUDES SPECIMEN VALIDITY TESTING, PER DAY; 22 OR MORE DRUG CLASS(ES), INCLUDING METABOLITE(S) IF PERFORMED
G0659 DRUG TEST(S), DEFINITIVE, UTILIZING DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING BUT NOT LIMITED TO GC/MS (ANY TYPE, SINGLE OR TANDEM) AND LC/MS (ANY TYPE, SINGLE OR TANDEM), EXCLUDING IMMUNOASSAYS (E.G., IA, EIA, ELISA, EMIT, FPIA) AND ENZYMATIC METHODS (E.G., ALCOHOL DEHYDROGENASE), PERFORMED WITHOUT METHOD OR DRUG-SPECIFIC CALIBRATION, WITHOUT MATRIX-MATCHED QUALITY CONTROL MATERIAL, OR WITHOUT USE OF STABLE ISOTOPE OR OTHER UNIVERSALLY RECOGNIZED INTERNAL STANDARD(S) FOR EACH DRUG, DRUG METABOLITE OR DRUG CLASS PER SPECIMEN; QUALITATIVE OR QUANTITATIVE, ALL SOURCES, INCLUDES SPECIMEN VALIDITY TESTING, PER DAY, ANY NUMBER OF DRUG CLASSES
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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(394 Codes)
Group 1 Paragraph

G0480, G0481, G0482, G0483, G0659, 80305, 80306, 80307.

Diagnosis codes must be coded to the highest level of specificity.

For codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter or S sequela may be used.

Group 1 Codes
Code Description
E87.20 Acidosis, unspecified
E87.21 Acute metabolic acidosis
E87.22 Chronic metabolic acidosis
E87.29 Other acidosis
F10.11 Alcohol abuse, in remission
F10.20 Alcohol dependence, uncomplicated
F11.11 Opioid abuse, in remission
F11.20 Opioid dependence, uncomplicated
F11.220 Opioid dependence with intoxication, uncomplicated
F11.221 Opioid dependence with intoxication delirium
F11.222 Opioid dependence with intoxication with perceptual disturbance
F11.229 Opioid dependence with intoxication, unspecified
F11.23 Opioid dependence with withdrawal
F11.250 Opioid dependence with opioid-induced psychotic disorder with delusions
F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations
F11.259 Opioid dependence with opioid-induced psychotic disorder, unspecified
F11.281 Opioid dependence with opioid-induced sexual dysfunction
F11.282 Opioid dependence with opioid-induced sleep disorder
F11.288 Opioid dependence with other opioid-induced disorder
F11.29 Opioid dependence with unspecified opioid-induced disorder
F12.11 Cannabis abuse, in remission
F13.11 Sedative, hypnotic or anxiolytic abuse, in remission
F14.11 Cocaine abuse, in remission
F15.11 Other stimulant abuse, in remission
F16.11 Hallucinogen abuse, in remission
F18.10 Inhalant abuse, uncomplicated
F18.11 Inhalant abuse, in remission
F18.120 Inhalant abuse with intoxication, uncomplicated
F18.90 Inhalant use, unspecified, uncomplicated
F19.20 Other psychoactive substance dependence, uncomplicated
F20.0 Paranoid schizophrenia
F20.1 Disorganized schizophrenia
F20.2 Catatonic schizophrenia
F20.89 Other schizophrenia
F55.0 Abuse of antacids
F55.1 Abuse of herbal or folk remedies
F55.2 Abuse of laxatives
F55.3 Abuse of steroids or hormones
F55.4 Abuse of vitamins
F55.8 Abuse of other non-psychoactive substances
G40.301 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus
G40.309 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus
G40.311 Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus
G40.319 Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus
G40.401 Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus
G40.409 Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus
G40.411 Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus
G40.419 Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus
G40.901 Epilepsy, unspecified, not intractable, with status epilepticus
G40.909 Epilepsy, unspecified, not intractable, without status epilepticus
G40.911 Epilepsy, unspecified, intractable, with status epilepticus
G40.919 Epilepsy, unspecified, intractable, without status epilepticus
G89.29 Other chronic pain
G89.4 Chronic pain syndrome
I44.0 Atrioventricular block, first degree
I44.1 Atrioventricular block, second degree
I44.30 Unspecified atrioventricular block
I45.81 Long QT syndrome
I47.0 Re-entry ventricular arrhythmia
I47.11 Inappropriate sinus tachycardia, so stated
I47.19 Other supraventricular tachycardia
I47.20 Ventricular tachycardia, unspecified
I47.21 Torsades de pointes
I47.29 Other ventricular tachycardia
I49.2 Junctional premature depolarization
M25.50 Pain in unspecified joint
M47.21 Other spondylosis with radiculopathy, occipito-atlanto-axial region
M47.22 Other spondylosis with radiculopathy, cervical region
M47.23 Other spondylosis with radiculopathy, cervicothoracic region
M47.26 Other spondylosis with radiculopathy, lumbar region
M47.27 Other spondylosis with radiculopathy, lumbosacral region
M47.28 Other spondylosis with radiculopathy, sacral and sacrococcygeal region
M47.811 Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region
M47.812 Spondylosis without myelopathy or radiculopathy, cervical region
M47.813 Spondylosis without myelopathy or radiculopathy, cervicothoracic region
M47.816 Spondylosis without myelopathy or radiculopathy, lumbar region
M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region
M47.818 Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region
M47.891 Other spondylosis, occipito-atlanto-axial region
M47.892 Other spondylosis, cervical region
M47.893 Other spondylosis, cervicothoracic region
M47.896 Other spondylosis, lumbar region
M47.897 Other spondylosis, lumbosacral region
M47.898 Other spondylosis, sacral and sacrococcygeal region
M51.14 Intervertebral disc disorders with radiculopathy, thoracic region
M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region
M51.16 Intervertebral disc disorders with radiculopathy, lumbar region
M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region
M51.36 Other intervertebral disc degeneration, lumbar region
M51.37 Other intervertebral disc degeneration, lumbosacral region
M54.14 Radiculopathy, thoracic region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy, lumbosacral region
M54.18 Radiculopathy, sacral and sacrococcygeal region
M54.2 Cervicalgia
M54.51 Vertebrogenic low back pain
M54.9 Dorsalgia, unspecified
M60.811 Other myositis, right shoulder
M60.812 Other myositis, left shoulder
M60.821 Other myositis, right upper arm
M60.822 Other myositis, left upper arm
M60.831 Other myositis, right forearm
M60.832 Other myositis, left forearm
M60.841 Other myositis, right hand
M60.842 Other myositis, left hand
M60.851 Other myositis, right thigh
M60.852 Other myositis, left thigh
M60.861 Other myositis, right lower leg
M60.862 Other myositis, left lower leg
M60.871 Other myositis, right ankle and foot
M60.872 Other myositis, left ankle and foot
M60.88 Other myositis, other site
M60.89 Other myositis, multiple sites
M60.9 Myositis, unspecified
M79.10 Myalgia, unspecified site
M79.11 Myalgia of mastication muscle
M79.12 Myalgia of auxiliary muscles, head and neck
M79.18 Myalgia, other site
M79.2 Neuralgia and neuritis, unspecified
M79.7 Fibromyalgia
R40.0 Somnolence
R40.1 Stupor
R40.20 Unspecified coma
R40.2110 Coma scale, eyes open, never, unspecified time
R40.2111 Coma scale, eyes open, never, in the field [EMT or ambulance]
R40.2112 Coma scale, eyes open, never, at arrival to emergency department
R40.2113 Coma scale, eyes open, never, at hospital admission
R40.2114 Coma scale, eyes open, never, 24 hours or more after hospital admission
R40.2120 Coma scale, eyes open, to pain, unspecified time
R40.2121 Coma scale, eyes open, to pain, in the field [EMT or ambulance]
R40.2122 Coma scale, eyes open, to pain, at arrival to emergency department
R40.2123 Coma scale, eyes open, to pain, at hospital admission
R40.2124 Coma scale, eyes open, to pain, 24 hours or more after hospital admission
R40.2210 Coma scale, best verbal response, none, unspecified time
R40.2211 Coma scale, best verbal response, none, in the field [EMT or ambulance]
R40.2212 Coma scale, best verbal response, none, at arrival to emergency department
R40.2213 Coma scale, best verbal response, none, at hospital admission
R40.2214 Coma scale, best verbal response, none, 24 hours or more after hospital admission
R40.2220 Coma scale, best verbal response, incomprehensible words, unspecified time
R40.2221 Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance]
R40.2222 Coma scale, best verbal response, incomprehensible words, at arrival to emergency department
R40.2223 Coma scale, best verbal response, incomprehensible words, at hospital admission
R40.2224 Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission
R40.2310 Coma scale, best motor response, none, unspecified time
R40.2311 Coma scale, best motor response, none, in the field [EMT or ambulance]
R40.2312 Coma scale, best motor response, none, at arrival to emergency department
R40.2313 Coma scale, best motor response, none, at hospital admission
R40.2314 Coma scale, best motor response, none, 24 hours or more after hospital admission
R40.2320 Coma scale, best motor response, extension, unspecified time
R40.2321 Coma scale, best motor response, extension, in the field [EMT or ambulance]
R40.2322 Coma scale, best motor response, extension, at arrival to emergency department
R40.2323 Coma scale, best motor response, extension, at hospital admission
R40.2324 Coma scale, best motor response, extension, 24 hours or more after hospital admission
R40.2340 Coma scale, best motor response, flexion withdrawal, unspecified time
R40.2341 Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance]
R40.2342 Coma scale, best motor response, flexion withdrawal, at arrival to emergency department
R40.2343 Coma scale, best motor response, flexion withdrawal, at hospital admission
R40.2344 Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission
R40.2A Nontraumatic coma due to underlying condition
R44.0 Auditory hallucinations
R44.2 Other hallucinations
R56.9 Unspecified convulsions
T14.91XA Suicide attempt, initial encounter
T14.91XD Suicide attempt, subsequent encounter
T14.91XS Suicide attempt, sequela
T39.011A Poisoning by aspirin, accidental (unintentional), initial encounter
T39.012A Poisoning by aspirin, intentional self-harm, initial encounter
T39.013A Poisoning by aspirin, assault, initial encounter
T39.014A Poisoning by aspirin, undetermined, initial encounter
T39.091A Poisoning by salicylates, accidental (unintentional), initial encounter
T39.092A Poisoning by salicylates, intentional self-harm, initial encounter
T39.093A Poisoning by salicylates, assault, initial encounter
T39.094A Poisoning by salicylates, undetermined, initial encounter
T39.1X1A Poisoning by 4-Aminophenol derivatives, accidental (unintentional), initial encounter
T39.1X2A Poisoning by 4-Aminophenol derivatives, intentional self-harm, initial encounter
T39.1X3A Poisoning by 4-Aminophenol derivatives, assault, initial encounter
T39.1X4A Poisoning by 4-Aminophenol derivatives, undetermined, initial encounter
T39.2X1A Poisoning by pyrazolone derivatives, accidental (unintentional), initial encounter
T39.2X2A Poisoning by pyrazolone derivatives, intentional self-harm, initial encounter
T39.2X3A Poisoning by pyrazolone derivatives, assault, initial encounter
T39.2X4A Poisoning by pyrazolone derivatives, undetermined, initial encounter
T39.311A Poisoning by propionic acid derivatives, accidental (unintentional), initial encounter
T39.312A Poisoning by propionic acid derivatives, intentional self-harm, initial encounter
T39.313A Poisoning by propionic acid derivatives, assault, initial encounter
T39.314A Poisoning by propionic acid derivatives, undetermined, initial encounter
T39.391A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], accidental (unintentional), initial encounter
T39.392A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], intentional self-harm, initial encounter
T39.393A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], assault, initial encounter
T39.394A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], undetermined, initial encounter
T40.0X1A Poisoning by opium, accidental (unintentional), initial encounter
T40.0X2A Poisoning by opium, intentional self-harm, initial encounter
T40.0X3A Poisoning by opium, assault, initial encounter
T40.0X4A Poisoning by opium, undetermined, initial encounter
T40.1X1A Poisoning by heroin, accidental (unintentional), initial encounter
T40.1X2A Poisoning by heroin, intentional self-harm, initial encounter
T40.1X3A Poisoning by heroin, assault, initial encounter
T40.1X4A Poisoning by heroin, undetermined, initial encounter
T40.2X1A Poisoning by other opioids, accidental (unintentional), initial encounter
T40.2X2A Poisoning by other opioids, intentional self-harm, initial encounter
T40.2X3A Poisoning by other opioids, assault, initial encounter
T40.2X4A Poisoning by other opioids, undetermined, initial encounter
T40.3X1A Poisoning by methadone, accidental (unintentional), initial encounter
T40.3X2A Poisoning by methadone, intentional self-harm, initial encounter
T40.3X3A Poisoning by methadone, assault, initial encounter
T40.3X4A Poisoning by methadone, undetermined, initial encounter
T40.491A Poisoning by other synthetic narcotics, accidental (unintentional), initial encounter
T40.491D Poisoning by other synthetic narcotics, accidental (unintentional), subsequent encounter
T40.491S Poisoning by other synthetic narcotics, accidental (unintentional), sequela
T40.492A Poisoning by other synthetic narcotics, intentional self-harm, initial encounter
T40.492D Poisoning by other synthetic narcotics, intentional self-harm, subsequent encounter
T40.492S Poisoning by other synthetic narcotics, intentional self-harm, sequela
T40.493A Poisoning by other synthetic narcotics, assault, initial encounter
T40.493D Poisoning by other synthetic narcotics, assault, subsequent encounter
T40.493S Poisoning by other synthetic narcotics, assault, sequela
T40.494A Poisoning by other synthetic narcotics, undetermined, initial encounter
T40.494D Poisoning by other synthetic narcotics, undetermined, subsequent encounter
T40.494S Poisoning by other synthetic narcotics, undetermined, sequela
T40.601A Poisoning by unspecified narcotics, accidental (unintentional), initial encounter
T40.602A Poisoning by unspecified narcotics, intentional self-harm, initial encounter
T40.603A Poisoning by unspecified narcotics, assault, initial encounter
T40.604A Poisoning by unspecified narcotics, undetermined, initial encounter
T40.691A Poisoning by other narcotics, accidental (unintentional), initial encounter
T40.692A Poisoning by other narcotics, intentional self-harm, initial encounter
T40.693A Poisoning by other narcotics, assault, initial encounter
T40.694A Poisoning by other narcotics, undetermined, initial encounter
T40.711A Poisoning by cannabis, accidental (unintentional), initial encounter
T40.711D Poisoning by cannabis, accidental (unintentional), subsequent encounter
T40.711S Poisoning by cannabis, accidental (unintentional), sequela
T40.712A Poisoning by cannabis, intentional self-harm, initial encounter
T40.712D Poisoning by cannabis, intentional self-harm, subsequent encounter
T40.712S Poisoning by cannabis, intentional self-harm, sequela
T40.713A Poisoning by cannabis, assault, initial encounter
T40.713D Poisoning by cannabis, assault, subsequent encounter
T40.713S Poisoning by cannabis, assault, sequela
T40.714A Poisoning by cannabis, undetermined, initial encounter
T40.714D Poisoning by cannabis, undetermined, subsequent encounter
T40.714S Poisoning by cannabis, undetermined, sequela
T40.8X1A Poisoning by lysergide [LSD], accidental (unintentional), initial encounter
T40.8X2A Poisoning by lysergide [LSD], intentional self-harm, initial encounter
T40.8X3A Poisoning by lysergide [LSD], assault, initial encounter
T40.8X4A Poisoning by lysergide [LSD], undetermined, initial encounter
T40.901A Poisoning by unspecified psychodysleptics [hallucinogens], accidental (unintentional), initial encounter
T40.902A Poisoning by unspecified psychodysleptics [hallucinogens], intentional self-harm, initial encounter
T40.903A Poisoning by unspecified psychodysleptics [hallucinogens], assault, initial encounter
T40.904A Poisoning by unspecified psychodysleptics [hallucinogens], undetermined, initial encounter
T40.991A Poisoning by other psychodysleptics [hallucinogens], accidental (unintentional), initial encounter
T40.992A Poisoning by other psychodysleptics [hallucinogens], intentional self-harm, initial encounter
T40.993A Poisoning by other psychodysleptics [hallucinogens], assault, initial encounter
T40.994A Poisoning by other psychodysleptics [hallucinogens], undetermined, initial encounter
T42.0X1A Poisoning by hydantoin derivatives, accidental (unintentional), initial encounter
T42.0X2A Poisoning by hydantoin derivatives, intentional self-harm, initial encounter
T42.0X3A Poisoning by hydantoin derivatives, assault, initial encounter
T42.0X4A Poisoning by hydantoin derivatives, undetermined, initial encounter
T42.3X1A Poisoning by barbiturates, accidental (unintentional), initial encounter
T42.3X2A Poisoning by barbiturates, intentional self-harm, initial encounter
T42.3X3A Poisoning by barbiturates, assault, initial encounter
T42.3X4A Poisoning by barbiturates, undetermined, initial encounter
T42.4X1A Poisoning by benzodiazepines, accidental (unintentional), initial encounter
T42.4X2A Poisoning by benzodiazepines, intentional self-harm, initial encounter
T42.4X3A Poisoning by benzodiazepines, assault, initial encounter
T42.4X4A Poisoning by benzodiazepines, undetermined, initial encounter
T42.6X1A Poisoning by other antiepileptic and sedative-hypnotic drugs, accidental (unintentional), initial encounter
T42.6X2A Poisoning by other antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter
T42.6X3A Poisoning by other antiepileptic and sedative-hypnotic drugs, assault, initial encounter
T42.6X4A Poisoning by other antiepileptic and sedative-hypnotic drugs, undetermined, initial encounter
T42.71XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, accidental (unintentional), initial encounter
T42.72XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter
T42.73XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, assault, initial encounter
T42.74XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, undetermined, initial encounter
T43.011A Poisoning by tricyclic antidepressants, accidental (unintentional), initial encounter
T43.012A Poisoning by tricyclic antidepressants, intentional self-harm, initial encounter
T43.013A Poisoning by tricyclic antidepressants, assault, initial encounter
T43.014A Poisoning by tricyclic antidepressants, undetermined, initial encounter
T43.021A Poisoning by tetracyclic antidepressants, accidental (unintentional), initial encounter
T43.022A Poisoning by tetracyclic antidepressants, intentional self-harm, initial encounter
T43.023A Poisoning by tetracyclic antidepressants, assault, initial encounter
T43.024A Poisoning by tetracyclic antidepressants, undetermined, initial encounter
T43.1X1A Poisoning by monoamine-oxidase-inhibitor antidepressants, accidental (unintentional), initial encounter
T43.1X2A Poisoning by monoamine-oxidase-inhibitor antidepressants, intentional self-harm, initial encounter
T43.1X3A Poisoning by monoamine-oxidase-inhibitor antidepressants, assault, initial encounter
T43.1X4A Poisoning by monoamine-oxidase-inhibitor antidepressants, undetermined, initial encounter
T43.201A Poisoning by unspecified antidepressants, accidental (unintentional), initial encounter
T43.202A Poisoning by unspecified antidepressants, intentional self-harm, initial encounter
T43.203A Poisoning by unspecified antidepressants, assault, initial encounter
T43.204A Poisoning by unspecified antidepressants, undetermined, initial encounter
T43.211A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, accidental (unintentional), initial encounter
T43.212A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, intentional self-harm, initial encounter
T43.213A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, assault, initial encounter
T43.214A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, undetermined, initial encounter
T43.221A Poisoning by selective serotonin reuptake inhibitors, accidental (unintentional), initial encounter
T43.222A Poisoning by selective serotonin reuptake inhibitors, intentional self-harm, initial encounter
T43.223A Poisoning by selective serotonin reuptake inhibitors, assault, initial encounter
T43.224A Poisoning by selective serotonin reuptake inhibitors, undetermined, initial encounter
T43.291A Poisoning by other antidepressants, accidental (unintentional), initial encounter
T43.292A Poisoning by other antidepressants, intentional self-harm, initial encounter
T43.293A Poisoning by other antidepressants, assault, initial encounter
T43.294A Poisoning by other antidepressants, undetermined, initial encounter
T43.3X1A Poisoning by phenothiazine antipsychotics and neuroleptics, accidental (unintentional), initial encounter
T43.3X2A Poisoning by phenothiazine antipsychotics and neuroleptics, intentional self-harm, initial encounter
T43.3X3A Poisoning by phenothiazine antipsychotics and neuroleptics, assault, initial encounter
T43.3X4A Poisoning by phenothiazine antipsychotics and neuroleptics, undetermined, initial encounter
T43.4X1A Poisoning by butyrophenone and thiothixene neuroleptics, accidental (unintentional), initial encounter
T43.4X2A Poisoning by butyrophenone and thiothixene neuroleptics, intentional self-harm, initial encounter
T43.4X3A Poisoning by butyrophenone and thiothixene neuroleptics, assault, initial encounter
T43.4X4A Poisoning by butyrophenone and thiothixene neuroleptics, undetermined, initial encounter
T43.501A Poisoning by unspecified antipsychotics and neuroleptics, accidental (unintentional), initial encounter
T43.502A Poisoning by unspecified antipsychotics and neuroleptics, intentional self-harm, initial encounter
T43.503A Poisoning by unspecified antipsychotics and neuroleptics, assault, initial encounter
T43.504A Poisoning by unspecified antipsychotics and neuroleptics, undetermined, initial encounter
T43.591A Poisoning by other antipsychotics and neuroleptics, accidental (unintentional), initial encounter
T43.592A Poisoning by other antipsychotics and neuroleptics, intentional self-harm, initial encounter
T43.593A Poisoning by other antipsychotics and neuroleptics, assault, initial encounter
T43.594A Poisoning by other antipsychotics and neuroleptics, undetermined, initial encounter
T43.601A Poisoning by unspecified psychostimulants, accidental (unintentional), initial encounter
T43.602A Poisoning by unspecified psychostimulants, intentional self-harm, initial encounter
T43.603A Poisoning by unspecified psychostimulants, assault, initial encounter
T43.604A Poisoning by unspecified psychostimulants, undetermined, initial encounter
T43.611A Poisoning by caffeine, accidental (unintentional), initial encounter
T43.612A Poisoning by caffeine, intentional self-harm, initial encounter
T43.613A Poisoning by caffeine, assault, initial encounter
T43.614A Poisoning by caffeine, undetermined, initial encounter
T43.621A Poisoning by amphetamines, accidental (unintentional), initial encounter
T43.622A Poisoning by amphetamines, intentional self-harm, initial encounter
T43.623A Poisoning by amphetamines, assault, initial encounter
T43.624A Poisoning by amphetamines, undetermined, initial encounter
T43.631A Poisoning by methylphenidate, accidental (unintentional), initial encounter
T43.632A Poisoning by methylphenidate, intentional self-harm, initial encounter
T43.633A Poisoning by methylphenidate, assault, initial encounter
T43.634A Poisoning by methylphenidate, undetermined, initial encounter
T43.641A Poisoning by ecstasy, accidental (unintentional), initial encounter
T43.641D Poisoning by ecstasy, accidental (unintentional), subsequent encounter
T43.641S Poisoning by ecstasy, accidental (unintentional), sequela
T43.642A Poisoning by ecstasy, intentional self-harm, initial encounter
T43.642D Poisoning by ecstasy, intentional self-harm, subsequent encounter
T43.642S Poisoning by ecstasy, intentional self-harm, sequela
T43.643A Poisoning by ecstasy, assault, initial encounter
T43.643D Poisoning by ecstasy, assault, subsequent encounter
T43.643S Poisoning by ecstasy, assault, sequela
T43.644A Poisoning by ecstasy, undetermined, initial encounter
T43.644D Poisoning by ecstasy, undetermined, subsequent encounter
T43.644S Poisoning by ecstasy, undetermined, sequela
T43.691A Poisoning by other psychostimulants, accidental (unintentional), initial encounter
T43.692A Poisoning by other psychostimulants, intentional self-harm, initial encounter
T43.693A Poisoning by other psychostimulants, assault, initial encounter
T43.694A Poisoning by other psychostimulants, undetermined, initial encounter
T43.8X1A Poisoning by other psychotropic drugs, accidental (unintentional), initial encounter
T43.8X2A Poisoning by other psychotropic drugs, intentional self-harm, initial encounter
T43.8X3A Poisoning by other psychotropic drugs, assault, initial encounter
T43.8X4A Poisoning by other psychotropic drugs, undetermined, initial encounter
T43.91XA Poisoning by unspecified psychotropic drug, accidental (unintentional), initial encounter
T43.92XA Poisoning by unspecified psychotropic drug, intentional self-harm, initial encounter
T43.93XA Poisoning by unspecified psychotropic drug, assault, initial encounter
T43.94XA Poisoning by unspecified psychotropic drug, undetermined, initial encounter
T45.0X1A Poisoning by antiallergic and antiemetic drugs, accidental (unintentional), initial encounter
T45.0X2A Poisoning by antiallergic and antiemetic drugs, intentional self-harm, initial encounter
T45.0X3A Poisoning by antiallergic and antiemetic drugs, assault, initial encounter
T45.0X4A Poisoning by antiallergic and antiemetic drugs, undetermined, initial encounter
T46.0X1A Poisoning by cardiac-stimulant glycosides and drugs of similar action, accidental (unintentional), initial encounter
T46.0X2A Poisoning by cardiac-stimulant glycosides and drugs of similar action, intentional self-harm, initial encounter
T46.0X3A Poisoning by cardiac-stimulant glycosides and drugs of similar action, assault, initial encounter
T46.0X4A Poisoning by cardiac-stimulant glycosides and drugs of similar action, undetermined, initial encounter
T50.901A Poisoning by unspecified drugs, medicaments and biological substances, accidental (unintentional), initial encounter
T50.902A Poisoning by unspecified drugs, medicaments and biological substances, intentional self-harm, initial encounter
T50.903A Poisoning by unspecified drugs, medicaments and biological substances, assault, initial encounter
T50.904A Poisoning by unspecified drugs, medicaments and biological substances, undetermined, initial encounter
T50.911A Poisoning by multiple unspecified drugs, medicaments and biological substances, accidental (unintentional), initial encounter
T50.912A Poisoning by multiple unspecified drugs, medicaments and biological substances, intentional self-harm, initial encounter
T50.913A Poisoning by multiple unspecified drugs, medicaments and biological substances, assault, initial encounter
T50.914A Poisoning by multiple unspecified drugs, medicaments and biological substances, undetermined, initial encounter
T50.915A Adverse effect of multiple unspecified drugs, medicaments and biological substances, initial encounter
T50.915D Adverse effect of multiple unspecified drugs, medicaments and biological substances, subsequent encounter
T50.915S Adverse effect of multiple unspecified drugs, medicaments and biological substances, sequela
T50.916A Underdosing of multiple unspecified drugs, medicaments and biological substances, initial encounter
T50.916D Underdosing of multiple unspecified drugs, medicaments and biological substances, subsequent encounter
T50.916S Underdosing of multiple unspecified drugs, medicaments and biological substances, sequela
Z51.81 Encounter for therapeutic drug level monitoring
Z79.3 Long term (current) use of hormonal contraceptives
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy
Z91.190 Patient's noncompliance with other medical treatment and regimen due to financial hardship
Z91.198 Patient's noncompliance with other medical treatment and regimen for other reason
Z91.199 Patient's noncompliance with other medical treatment and regimen due to unspecified reason
Z91.A10 Caregiver's noncompliance with patient's dietary regimen due to financial hardship
Z91.A18 Caregiver's noncompliance with patient's dietary regimen for other reason
Z91.A20 Caregiver's intentional underdosing of patient's medication regimen due to financial hardship
Z91.A28 Caregiver's intentional underdosing of medication regimen for other reason
Z91.A3 Caregiver's unintentional underdosing of patient's medication regimen
Z91.A41 Caregiver's other noncompliance with patient's medication regimen due to financial hardship
Z91.A48 Caregiver's other noncompliance with patient's medication regimen for other reason
Z91.A51 Caregiver's noncompliance with patient's renal dialysis due to financial hardship
Z91.A58 Caregiver's noncompliance with patient's renal dialysis for other reason
Z91.A91 Caregiver's noncompliance with patient's other medical treatment and regimen due to financial hardship
Z91.A98 Caregiver's noncompliance with patient's other medical treatment and regimen for other reason
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/15/2023 R22

Revision Effective: 10/01/2023
Revision Explanation: Annual ICD-10 update. Added the following: R40.2A.

10/15/2023 R21

Revision Effective: 10/01/2023 
Revision Explanation: Annual ICD-10 update, Deleted the following codes from Group 1: I47.1, Z91.A4 Z91.A5 Z91.A9. Added the following codes to Group 1: I47.11, I47.19, Z91.A41, Z91.A48, Z91.A51, Z91.A58, Z91.A91, and Z91.A98.

10/15/2023 R20

Revision Effective: 10/15/2023
Revision Explanation: Release to final after open comment. Group 2 incorporated into group 1 HCPCS list. Added the following dx: F10.11, F10.20, F11.11, F11.220, F11.221, F11.222, F11.229, F11.250, F11.251, F11.259, F11.281, F11.282, F11.288, F11.29, F12.11, F14.11, F15.11, F16.11, F18.11, F55.0, F55.1, F55.2, F55.4, G40.301, G40.309, G40.311, G40.319, G40.401, G40.409, G40.411, G40.419, G40.901, G40.909, G40.911, G40.919, G89.29, G89.4, I44.0, I44.1, I44.30, I47.0, I47.1, I49.2, M25.50, M47.21, M47.22, M47.23, M47.26, M47.27, M47.28, M47.811, M47.812, M47.813, M47.816, M47.817, M47.818, M47.891, M47.892, M47.893, M47.896, M47.897, M47.898, M51.14, M51.15, M51.16, M51.17, M51.36, M51.37, M54.14, M54.15, M54.16, M54.17, M54.18, M54.2, M54.51, M54.9, M60.811, M60.812, M60.821, M60.822, M60.831, M60.832, M60.841, M60.842, M60.851, M60.852, M60.861, M60.862, M60.871, M60.872, M60.88, M60.89, M60.9, M79.10, M79.11, M79.12, M79.18, M79.2, M79.7, R40.20, T14.91XA, T14.91XD, T14.91XS, T50.915A, T50.915D, T50.915S, T50.916A, T50.916D, T50.916S, Z51.81, Z79.3, Z91.199, Z91.A10, Z91.A18, Z91.A20, Z91.A28, Z91.A3, Z91.A4, Z91.A5, Z91.A9. Removed the following dx: F11.13, F12.13, F12.23, F12.93, F13.130, F13.131, F13.132, F14.13, F14.91, F14.93, F15.13, F18.91, F19.130, F19.131, F19.132, R41.0, R41.82, T40.411A, T40.411D, T40.411S,T40.412A, T40.412D, T40.412S, T40.413A, T40.413D, T40.413S, T40.414A, T40.414D, T40.414S, T40.421A, T40.421D, T40.421S, T40.422A, T40.422D, T40.422S, T40.423A, T40.423D, T40.423S, T40.424A, T40.424D, T40.424S, T40.5X1A, T40.5X1D, T40.5X1S, T40.5X2A, T40.5X2D, T40.5X2S, T40.5X3A, T40.5X3D, T40.5X3S, T40.5X4A, T40.5X4D, T40.5X4S, T40.721A, T40.721D, T40.721S, T40.722A, T40.722D, T40.722S, T40.723A, T40.723D, T40.723S, T40.724A, T40.724D, T40.724S, T43.651A, T43.651D, T43.651S, T43.652A, T43.652D, T43.652S, T43.653A, T43.653D, T43.653S, T43.654A, T43.654D, T43.654S, T43.655A, T43.655D, T43.655S, Z03.89, Z91.120, Z91.128, Z91.130, Z91.138, Z91.14

03/09/2023 R19

Revision Effective: 03/03/2023
Revision Explanation: Annual review, no changes 

10/01/2022 R18

Revision Effective: 10/01/2022
Revision Explanation: Correction to R17-The revision effective date is 10/01/2022. Annual ICD-10 Update, Removed E87.2, I47.2, Z91.19 and added E87.21, E87.22, E87.29, I47.21, I47.29, Z91.190, Z91.198, and Z91.199 

10/01/2022 R17

R17

Revision Effective: 09/19/2022
Revision Explanation: Annual ICD-10 Update, added F12.91, F14.91, F18.91, T43.651A, T43.651D, T43.651S, T43.652A, T43.652D, T43.652S, T43.653A, T43.653D, T43.653S
T43.654A, T43.654D, T43.654S, T43.655A, T43.655D, T43.655S, T43.656A, T43.656D, T43.656S, Z03.83, and Z79.85

 

02/10/2022 R16

R16

Revision Effective: 02/10/2022
Revision Explanation: Annual review, no changes were made.

10/01/2021 R15

R15

Revision Effective: 10/01/2021
Revision Explanation: ICD-10 codes M79.10-M79.12 were removed inn error during annual ICD-10 update and have been added back.

10/01/2021 R14

R14
Revision Effective: 10/01/2021
Revision Explanation: Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted M54.5,T40.7X1A,T40.7X2A, T40.7X3A, T40.7X4A and added T40.711A, T40.711D, T40.711S, T40.712A, T40.712D, T40.712S, T40.713A, T40.713D, T40.713S, T40.714A, T40.714D, T40.714S, T40.721A, T40.721D, T40.721S, T40.722A, T40.722D, T40.722S, T40.723A, T40.723D, T40.723S, T40.724A, T40.724D, T40.724S. This revision is due to the Annual ICD-10 update and is effective on 10/1/21.

10/01/2021 R13

R13
Revision Effective: 10/01/2021
Revision Explanation: Annual ICD-10 update. Under ICD-10-CM Codes that Support Medical Necessity Group 1: Code added R45.88.

06/17/2021 R12

R12
Revision Effective: 06/17/2021
Revision Explanation: Annual review, no changes were made.

04/15/2021 R11

R11
Revision Effective: 03/08/2021
Revision Explanation: In revisions 5 and 7  ICD-10 codes F10.139, F13.139, and F19.139 were listed as being added under these revisons in error. These codes were actually being removed as there are more appropriate codes available.  Codes G40.901, G40.909, G40.911 and G40.919 were removed during these revisions but were not listed in the revision explanation. These unspecified codes were removed as there are more appropriate codes available.

04/01/2021 R10

R10
Revision Effective: 03/08/2021
Revision Explanation: The following ICD-10 codes have been removed, F11.229, F11.259, and F11.29,. There were to be removed during revision 7 but  were left in ICD-10 group1 in error. 

03/08/2021 R9

R9
Revision Effective: 01/01/2021
Revision Explanation: Under CMS National Coverage Policy added the regulation for CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1.2 - A/B MAC (B) Contacts with Independent Clinical Laboratories to this section. This revision has a retroactive effective date of 1/1/21.

Under CPT/HCPCS Codes Group 1: Codes added code 0227U due to the Q1 2021 CPT/HCPCS code update and has a retroactive effective date of 1/1/21.

03/08/2021 R8

R8
Revision Effective: 03/04/2021
Revision Explanation: Annual review, no changes were made.

03/08/2021 R7

R7
Revision Effective: 03/08/2021
Revision Explanation: When draft article was released to final with the policy the updates made in revision 5 from annual ICD-10 update was not added to the released article so it would have the updates. This has been corrected.

Group 1: Codes added codes F10.130, F10.131, F10.132, F10.139, F11.13, F12.13, F13.130, F13.131, F13.132, F13.139, F14.13, F14.93, F15.13, F19.130, F19.131, F19.132, F19.139, G40.42, M25.59, T40.411A, T40.411D, T40.411S, T40.412A, T40.412D, T40.412S, T40.413A, T40.413D, T40.413S, T40.414A, T40.414D, T40.414S, T40.421A, T40.421D, T40.421S, T40.422A, T40.422D, T40.422S, T40.423A, T40.423D, T40.423S, T40.424A, T40.424D, T40.424S, T40.491A, T40.491D, T40.491S, T40.492A, T40.492D, T40.492S, T40.493A, T40.493D, T40.493S, T40.494A, T40.494D, T40.494S, Z03.821, Z03.822, Z03.833, Z91.19 and deleted codes T40.4X1A, T40.4X2A, T40.4X3A, and T40.4X4A. This revision is due to the Annual ICD-10 Code Update and is effective on October 1, 2020. Removed the following unspecified codes as there are more applicable codes available: F11.229, f11.259, f11.29M25.50, M25.59, M60.9, R40.20.

03/08/2021 R6

R6
Revision Effective: 03/08/2021
Revision Explanation: Released article from draft, no changes made as no comments received. Policy in notice from 01/21/2021-03/07/2021. Policy and billing and Coding article effective 03/08/2021.

10/01/2020 R5

R5
Revision Effective:10/01/2020
Revision Explanation: Under ICD-10 Codes that Support Medical Necessity – Group 1: Codes added codes F10.130, F10.131, F10.132, F10.139, F11.13, F12.13, F13.130, F13.131, F13.132, F13.139, F14.13, F14.93, F15.13, F19.130, F19.131, F19.132, F19.139, G40.42, M25.59, T40.411A, T40.411D, T40.411S, T40.412A, T40.412D, T40.412S, T40.413A, T40.413D, T40.413S, T40.414A, T40.414D, T40.414S, T40.421A, T40.421D, T40.421S, T40.422A, T40.422D, T40.422S, T40.423A, T40.423D, T40.423S, T40.424A, T40.424D, T40.424S, T40.491A, T40.491D, T40.491S, T40.492A, T40.492D, T40.492S, T40.493A, T40.493D, T40.493S, T40.494A, T40.494D, T40.494S, Z03.821, Z03.822, Z03.833, Z91.19 and deleted codes T40.4X1A, T40.4X2A, T40.4X3A, and T40.4X4A. This revision is due to the Annual ICD-10 Code Update and is effective on October 1, 2020. Removed the following unspecified codes as there are more applicable codes available: F11.229, f11.259, f11.29M25.50, M25.59, M60.9, R40.20.

01/01/2020 R4

R4

Revision Effective: n/a

Revision Explanation: Annual review, no changes made.

01/01/2020 R3

R3

Revision Effective: 01/01/2020

Revision Explanation: Added new codes 0143U-0150U under CPT section based on annual HCPCS update effective 01/01/2020.

11/21/2019 R2

R2

Revision Effective: 11/21/2019

Revision Explanation: Added regulations in the CMS National policy section and added additional information in the article test concerning the billing of these tests.

09/19/2019 R1

R1

Revision Effective: 09/19/2019

Revision Explanation: Converted article into new Billing and Coding template no other changes made.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L36029 - Urine Drug Testing
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
11/07/2023 11/16/2023 - N/A Currently in Effect View
10/17/2023 10/15/2023 - 11/15/2023 Superseded You are here
09/13/2023 10/15/2023 - N/A Superseded View
08/24/2023 10/15/2023 - N/A Superseded View
02/28/2023 03/09/2023 - 10/14/2023 Superseded View
09/21/2022 10/01/2022 - 03/08/2023 Superseded View
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