Does 0447T require prior authorization?

No, 0447T does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 0447T?

Medicare facility rate: $56.45. Non-facility rate: $100.87. Work RVU: 1.31.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.31

Facility

$56.45

Non-Facility

$100.87

All documentation must be maintained in the patient's medical record, be legible, and include appropriate patient identification information and dates of service.
Medical records must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The 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 made available to the contractor upon request.

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.
Removal of an implanted I-CGM sensor is reportable/covered when performed and should be billed with CPT/HCPCS code 0447T.
Removal of an implanted I-CGM sensor with immediate insertion of a new implantable sensor is reportable/covered and should be billed with CPT/HCPCS code 0448T.
Implantation of an implantable continuous glucose monitor (I-CGM) that meets the criteria in LCD L38657/L38662 is reportable using CPT/HCPCS code 0446T for 90-, 180-, or 365-day implantable glucose sensors.
Removal of an implantable interstitial glucose sensor with immediate insertion of a new implantable sensor is reportable with CPT code 0447T.
Removal of an implantable interstitial glucose sensor with creation of a subcutaneous pocket at a different anatomic site and insertion of a new 90- or 180-day implantable sensor is reportable with CPT code 0448T, including system activation.

L35490 — Category III Codes

J05

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

J05

L38686 — 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.