Does 0446T require prior authorization?

No, 0446T does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 0446T?

Medicare facility rate: $48.77. Non-facility rate: $6320.12. Work RVU: 1.11.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.11

Facility

$48.77

Non-Facility

$6320.12

Maintain complete, legible medical records for all I-CGM services with patient identification (e.g., full name, dates of service) available to the contractor on request.
Medical record must include the legible signature of the physician or non-physician practitioner responsible for care.
Submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
All documentation must be maintained in the patient's medical record, be legible, and include appropriate patient identification information and dates of service.

Coverage for implantable continuous glucose monitor (I-CGM) procedures is allowed when reasonable and necessary per Local Coverage Determination L38617.
Insertion of an implantable interstitial glucose sensor (report CPT 0446T) for 90-day, 180-day, or 365-day sensors is covered when the procedure meets LCD L38617 reasonable and necessary requirements.
Removal of an implantable interstitial glucose sensor (report CPT 0447T) is covered when device removal is clinically indicated and documented.
Removal with immediate subsequent replacement at a different anatomic site (report CPT 0448T) is covered when clinically indicated and documented.
Replacement of a 90-day sensor with a 365-day sensor is allowed when one or more of the following is documented: patient discomfort or need for a different anatomical site, sensor has reached end of functional life, or provider documents sensor malfunction and recommends replacement.
Implantation of an implantable continuous glucose monitor (I-CGM) is covered when the device and procedure meet the reasonable and necessary criteria specified in LCD L38623.

L38686 — Implantable Continuous Glucose Monitors (I-CGM)

J05

L35490 — Category III Codes

J05

A58213 — Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

J05

L38623 — Implantable Continuous Glucose Monitors (I-CGM)

J06

A58116

Ask Verity about documentation requirements, denial risks, or coverage in your state.