T40.5X5A: Adverse effect of cocaine, initial encounter
T40.5X5A, adverse effect of cocaine, initial encounter, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 33 HCPCS Level II codes, including J2785 (Injection, regadenoson, 0.1 mg), J0461 (Injection, atropine sulfate, 0.01 mg), J3490 (Unclassified drugs). The articles come from 3 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with T40.5X5A as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J2785 | Injection, regadenoson, 0.1 mg | Carrier judgment | — | 1 |
| J0461 | Injection, atropine sulfate, 0.01 mg | Special coverage instructions apply | — | 1 |
| J3490 | Unclassified drugs | Special coverage instructions apply | — | 1 |
| J0153 | Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) | Special coverage instructions apply | — | 1 |
| Q9957 | Injection, perflutren lipid microspheres, per ml | Carrier judgment | — | 1 |
| J1250 | Injection, dobutamine hydrochloride, per 250 mg | Special coverage instructions apply | — | 1 |
| J0280 | Injection, aminophyllin, up to 250 mg | Special coverage instructions apply | — | 1 |
| J1245 | Injection, dipyridamole, per 10 mg | Special coverage instructions apply | — | 1 |
| Q9956 | Injection, octafluoropropane microspheres, per ml | Carrier judgment | — | 1 |
| C9399 | Unclassified drugs or biologicals | Special coverage instructions apply | — | 1 |
| A9700 | Supply of injectable contrast material for use in echocardiography, per study | Special coverage instructions apply | — | 1 |
| C8921 | Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete | Special coverage instructions apply | — | 1 |
| C8922 | Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited study | Special coverage instructions apply | — | 1 |
| C8923 | Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, without spectral or color doppler echocardiography | Special coverage instructions apply | — | 1 |
| C8924 | Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study | Special coverage instructions apply | — | 1 |
| C8928 | Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report | Special coverage instructions apply | — | 1 |
| C8929 | Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography | Special coverage instructions apply | — | 1 |
| C8930 | Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision | Special coverage instructions apply | — | 1 |
| Q9955 | Injection, perflexane lipid microspheres, per ml | Carrier judgment | — | 1 |
| 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 | Carrier judgment | — | 1 |
| 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 | Carrier judgment | — | 1 |
| 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 | Carrier judgment | — | 1 |
| 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 | Carrier judgment | — | 1 |
| 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 | Carrier judgment | — | 1 |
| G2187 | Patients with clinical indications for imaging of the head: head trauma | Carrier judgment | — | 1 |
8 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing T40.5X5A
- A57306: Billing and Coding: Transthoracic Echocardiography (TTE) (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 19 Level II codes). LCD with the same title: L33577, L34338
- A56645: Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35006, L36393
- A56612: Billing and Coding: CT of the Head (Palmetto GBA (MAC - Part A, MAC - Part B); 9 Level II codes). LCD with the same title: L34417
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other T40 diagnoses (Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics [hallucinogens])
- T40.5X1A — Poisoning by cocaine, accidental (unintentional), initial encounter
- T40.5X2A — Poisoning by cocaine, intentional self-harm, initial encounter
- T40.5X3A — Poisoning by cocaine, assault, initial encounter
- T40.5X4A — Poisoning by cocaine, 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
- T40.0X5A — Adverse effect of opium, 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…
- 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
- T40.2X5A — Adverse effect of other opioids, 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
- T40.3X5A — Adverse effect of methadone, initial encounter
- T40.491A — Poisoning by other synthetic narcotics, accidental (unintentional)…
- T40.492A — Poisoning by other synthetic narcotics, intentional self-harm…
- T40.493A — Poisoning by other synthetic narcotics, assault, initial encounter
- T40.494A — Poisoning by other synthetic narcotics, undetermined, initial…
- T40.495A — Adverse effect of other synthetic narcotics, initial encounter
- T40.601A — Poisoning by unspecified narcotics, accidental (unintentional)…
- T40.602A — Poisoning by unspecified narcotics, intentional self-harm, initial…
Frequently asked questions
Does Medicare cover T40.5X5A (Adverse effect of cocaine, initial encounter)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list T40.5X5A as a covered diagnosis for 33 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 T40.5X5A?
The Level II codes from the policies most specific to this diagnosis are J2785 (Injection, regadenoson, 0.1 mg, 1 article); J0461 (Injection, atropine sulfate, 0.01 mg, 1 article); J3490 (Unclassified drugs, 1 article); J0153 (Injection, adenosine, 1 mg (not to be used to report any…, 1 article); Q9957 (Injection, perflutren lipid microspheres, per ml, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list T40.5X5A?
A57306 (Billing and Coding: Transthoracic Echocardiography (TTE)); A56645 (Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing); A56612 (Billing and Coding: CT of the Head).
What is ICD-10-CM code T40.5X5A?
T40.5X5A is the ICD-10-CM code for adverse effect of cocaine, initial encounter, in category T40 (Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics [hallucinogens]), chapter 19: Injury, poisoning and other consequences of external causes.
Next steps
- Run a reimbursement report for a device billed under J2785
- Watch J2785 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2785
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 19: Injury, poisoning and other consequences of external causes · All diagnoses · HCPCS lookup