Does 26535 require prior authorization?

No, 26535 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 26535?

Medicare facility rate: $419.85. Non-facility rate: $419.85. Work RVU: 5.27.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

5.27

Facility

$419.85

Non-Facility

$419.85

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage but does not guarantee coverage of the service requested; 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, please check the member specific benefit plan document and any applicable federal or state mandates.

Surgery of the hand or wrist is proven and medically necessary in certain circumstances.
Arthroplasty, Carpometacarpal (CMC) Joint, Thumb (per InterQual® CP: Procedures).
Arthroplasty, Metacarpophalangeal (MCP) Joint, Digits (per InterQual® CP: Procedures).
Arthroplasty, Proximal Interphalangeal (PIP) Joint, Fingers (per InterQual® CP: Procedures).
Arthroscopy or Arthroscopically Assisted Surgery, Wrist (per InterQual® CP: Procedures).
Arthroscopy, Diagnostic, +/- Synovial Biopsy, Wrist (per InterQual® CP: Procedures).

UHC-POL-surgery-hand-wrist — Surgery of the Hand or Wrist

UMR-POL-UMR-surgery-hand-wrist — Surgery of the Hand or Wrist

SUREST-POL-SUREST-surgery-hand-wrist — Surgery of the Hand or Wrist

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