Does 00140 require prior authorization?

No, 00140 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 00140?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

A one-time infusion of betibeglogene autotemcel is consideredmedically necessaryin individuals whenallof the following criteria are met:
Diagnosis of beta thalassemia;and
Transfusion-dependent disease (that is, needing at least 8 transfusions or at least 100 ml per kilogram of body weight of packed red cells per year in the previous 2 years);and
The individual is a candidate for an allogeneic hematopoietic cell transplantation, but ineligible due the absence of a donor*;and
Has no evidence of severe iron overload (for example, T2*-weighted magnetic resonance imaging [MRI] measurements of myocardial iron greater than 10 msec);and
No serious concomitant illness (for example, advanced liver disease, uncorrected bleeding disorder, current malignancy, myeloproliferative and/or immunodeficiency disorder, uncontrolled seizure disorder).

ANTHEM-MED.00140 — MED.00140 Gene Therapy for Beta Thalassemia

ANTHEM-CG-MED-21 — CG-MED-21 Anesthesia Services and Moderate (âConsciousâ) Sedation

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