Does 0788T require prior authorization?

No, 0788T does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 0788T?

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

Voiding diaries documenting baseline and test-stimulation outcomes are required to measure the ≥50% improvement for urinary indications.
For fecal incontinence, documentation must show frequency (>2 incontinent episodes/week), duration (>6 months or >12 months after vaginal childbirth), and failure or intolerance of conventional therapies.
A percutaneous test stimulation report documenting at least 50% sustained (>1 week) improvement is required to support permanent implantation for fecal incontinence.
Medical records must document that the patient is refractory to conventional therapy (behavioral, pharmacologic and/or surgical) for urinary indications and is an appropriate surgical candidate able to undergo anesthesia.

Sacral nerve stimulation (SNS) is covered for urinary urge incontinence.
SNS is covered for urgency-frequency syndrome (urinary urgency-frequency).
SNS is covered for urinary retention.
Both a temporary test stimulation and subsequent permanent implantation of an implanted sacral electrode array are covered for appropriate candidates.
SNS is covered for fecal incontinence when all fecal-specific criteria are met (see limitations/frequency): chronic fecal incontinence with >2 incontinent episodes/week and duration >6 months or >12 months after vaginal childbirth.
Coverage for fecal incontinence requires documented failure or intolerance to conventional therapy (e.g., dietary modification, bulking agents, pharmacologic treatment).

PALMETTO-L39543, Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence

JJ Part B

BCBSMT-SUR710.018, Sacral Nerve Neuromodulation/Stimulation

BCBSNM-SUR710.018, Sacral Nerve Neuromodulation/Stimulation

BCBSOK-SUR710.018, Sacral Nerve Neuromodulation/Stimulation

BCBSIL-SUR712.009, Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation

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