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HCPCS/CPT 26045 | No Prior Auth, Medicare $453.25

Ask Verity/26045

`26045`

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

5.59

Facility

$453.25

Non-Facility

$453.25

Key Coverage Criteria

Surgical treatment for Dupuytrenâs contracture is consideredmedically necessarywhen a palpable palmar cord has been documented to impair the individualâs functional activitiesandany of the following:
Contracture at the proximal interphalangeal (PIP) joint or distal interphalangeal (DIP) joint of 20 degrees or more;or
Contracture at the metacarpophalangeal (MP) joint of 20 degrees or more;or
Symptomatic Dupuytrenâs contracture (that is, pain, tenderness, or functional impairment).

1 Active Policy

ANTHEM-CG-SURG-11 — CG-SURG-11 Surgical Treatment for Dupuytren's Contracture

Related Codes

26040(1 policies)M72.0(1 policies)

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