Does 24365 require prior authorization?

No, 24365 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 24365?

Medicare facility rate: $605.56. Non-facility rate: $605.56. Work RVU: 8.40.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

8.40

Facility

$605.56

Non-Facility

$605.56

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage; refer to the protocol titled Medical Records Documentation Used for Reviews.
When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan.
Before using this policy, check the member specific benefit plan document and any applicable federal or state mandates.

Surgery of the elbow when proven and medically necessary in circumstances that meet clinical coverage criteria
Arthroscopy, Diagnostic, +/- Synovial Biopsy, Elbow when it meets InterQual® CP criteria
Arthroscopy, Surgical, Elbow when it meets InterQual® CP criteria
Joint Replacement, Elbow when it meets InterQual® CP criteria
Removal or Revision, Arthroplasty, Elbow when it meets InterQual® CP criteria

UHC-POL-surgery-elbow — Surgery of the Elbow

UMR-POL-UMR-surgery-elbow — Surgery of the Elbow

SUREST-POL-SUREST-surgery-elbow — Surgery of the Elbow

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