Does 22590 require prior authorization?

Yes, 22590 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for 22590?

Medicare facility rate: $1559.15. Non-facility rate: $1559.15. Work RVU: 21.22.

HCPCS/CPT

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Work RVU

21.22

Facility

$1559.15

Non-Facility

$1559.15

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

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A59664 — Billing and Coding: Cervical Fusion

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A59632 — Billing and Coding: Cervical Fusion

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L39770 — Cervical Fusion

J06

L39799 — Cervical Fusion

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