Does 22552 require prior authorization?

No, 22552 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 22552?

Medicare facility rate: $353.05. Non-facility rate: $353.05. Work RVU: 6.34.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

6.34

Facility

$353.05

Non-Facility

$353.05

For diagnostic tests, report the test result if known; otherwise report the symptoms that prompted the performance of the test.
All documentation must be maintained in the patient's medical record, be legible, include appropriate patient identification and service dates, and include the legible signature of the physician or non-physician practitioner responsible for 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; the operative note must document the procedure performed and any associated or additional procedures performed at the same time.
The patient's medical record should include the performing provider's assessment related to the patient's complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports.

Cervical fusion and related procedures are covered when they meet the reasonable and necessary clinical criteria and frequency limits specified in Local Coverage Determination (LCD) L39738.
Cervical fusion and related cervical spine fusion procedures are covered when they meet the reasonable and necessary clinical and frequency criteria specified in Local Coverage Determination (LCD) L39758.
Cervical fusion and related cervical spine fusion procedures are the only procedures covered under this policy; other joint or non-cervical spinal procedures (e.g., facet, sacroiliitis, epidural) are not covered by this policy.
Coverage for a cervical fusion procedure is allowed only when the service meets the reasonable and necessary clinical criteria and frequency limitations specified in the applicable draft Local Coverage Determination (LCD) Cervical Fusion.
This billing/coding guidance applies only to cervical fusion and related cervical spine procedures and does not apply to other joint or non-cervical spinal procedures (e.g., facet, sacroiliitis, epidural, other spinal procedures).
Cervical fusion procedures are covered when they meet the reasonable and necessary clinical criteria and frequency limits specified in Local Coverage Determination (LCD) L39788.

L39788 — Cervical Fusion

J05

A59664 — Billing and Coding: Cervical Fusion

J05

A59632 — Billing and Coding: Cervical Fusion

J06

L39770 — Cervical Fusion

J06

L39799 — Cervical Fusion

J09

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