Does 0263T require prior authorization?

No, 0263T does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 0263T?

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

Use validated outcome measures to assess quality of life (QOL) and functional ability.
Document baseline and follow-up outcome measures to determine whether the condition improves, worsens, or remains stable and whether change is clinically significant.
Document assessment of net health outcome, including a balance of anticipated benefits and potential harms for the specific clinical condition.
Follow-up visits at approximately 3, 6, and 12 months after stem cell therapy to monitor outcomes (overall survival, symptoms, disease status, morbid events, functional outcomes, QOL, treatment-related morbidity including amputation rates, wound/ulcer healing, and pain-free walking distance)

Treatment of peripheral arterial disease (PAD), including critical limb ischemia characterized by ischemic rest pain, ulcers, or significant risk for limb loss
Use of stem cell therapy as a treatment option for individuals with peripheral arterial disease (PAD).
Hematopoietic or bone marrow–derived cell therapy intended to induce arteriogenesis in PAD by augmenting physiologic repair processes.
Peripheral arterial disease presenting as severe, limb-threatening ischemia.
Patients in whom revascularization has failed.
Patients for whom revascularization is not possible and who are at risk of amputation.

BCBSIL-SUR703.048 — Stem Cell Therapy for Peripheral Arterial Disease

BCBSMT-SUR703.048 — Stem Cell Therapy for Peripheral Arterial Disease

BCBSNM-SUR703.048 — Stem Cell Therapy for Peripheral Arterial Disease

BCBSOK-SUR703.048 — Stem Cell Therapy for Peripheral Arterial Disease

REGENCE-MED141 — Cell Therapy for Peripheral Arterial Disease

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