Does 0585T require prior authorization?

No, 0585T does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 0585T?

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

Refer to separate policy CP.MP.250 for criteria related to Lantidra (donislecel) allogeneic pancreatic islet cellular therapy.
Serial blood and urine testing may be required to verify abstinence from substances of concern.
Documentation of a commitment to reduce substance-use behaviors is acceptable when urgent transplant timelines exist (as evidence of risk-reduction intent).
Chart notes, emergency department records, or hospitalization records documenting the recurrent severe metabolic complications and specifying the type (e.g., hypoglycemia unawareness, severe hypoglycemic attacks, marked hyperglycemia, recurrent ketoacidosis).

Pancreas transplantation (SPK, PAK, PTA) and islet cell transplantation for patients with diabetes mellitus to arrest progression of diabetes-related complications and to improve quality of life.
Diagnosis of diabetes mellitus requiring insulin (members requiring >1 unit/kg should be closely evaluated as they may be less likely to benefit from pancreas transplant)
Diagnosis of exocrine pancreatic insufficiency
Requirement for procurement or transplantation of a pancreas as part of a multiple-organ transplant for technical reasons
Absence of any listed contraindications to pancreas transplantation
Progressive cognitive impairment

AMBETTER-CP.MP.102 — Pancreas Transplantation

BCBSIL-SUR703.057 — Islet Transplantation for Chronic Pancreatitis and Donislecel-jujn for Type 1 Diabetes

BCBSMT-SUR703.057 — Islet Transplantation for Chronic Pancreatitis and Donislecel-jujn for Type 1 Diabetes

BCBSNM-SUR703.057 — Islet Transplantation for Chronic Pancreatitis and Donislecel-jujn for Type 1 Diabetes

BCBSOK-SUR703.057

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