Does 28250 require prior authorization?

No, 28250 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 28250?

Medicare facility rate: $386.78. Non-facility rate: $599.21. Work RVU: 5.91.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

5.91

Facility

$386.78

Non-Facility

$599.21

Documentation to support the covered ICD-10 diagnosis (examples listed in policy: M72.2; M77.30 - M77.32).
For combined steroid/anesthetic injection: documentation that conservative treatments have failed — e.g., attempted stretching exercises, over-the-counter silicone heel shoe inserts, and 2 to 3 weeks of non-steroidal anti-inflammatory drugs (per the policy text: "when conservative treatments (e.g., stretching exercises, over-the-counter silicone heel shoe inserts, and 2 to 3 weeks of non-steroidal anti-inflammatory drugs) have failed").
For endoscopic plantar fasciotomy: documentation of intractable plantar fasciitis or heel spur syndrome and failure of a 6-month trial of conservative therapy (per the policy text: "who have failed a 6-month trial of conservative therapy").

Plantar fasciitis (including chronic/recalcitrant plantar fasciitis)
Painful calcaneal spur and plantar heel pain (conditions being evaluated for the listed treatments)
Combined steroid/anesthetic injection medically necessary for the treatment of plantar fascia when conservative treatments (e.g., stretching exercises, over-the-counter silicone heel shoe inserts, and 2 to 3 weeks of non-steroidal anti-inflammatory drugs) have failed.
Endoscopic plantar fasciotomy medically necessary as an alternative to conventional open plantar fasciotomy for members with intractable plantar fasciitis or heel spur syndrome who have failed a 6-month trial of conservative therapy.
CPT codes covered if selection criteria are met: 20550 (Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")) and 29893 (Endoscopic plantar fasciotomy).
ICD-10 codes covered if selection criteria are met: M72.2 (Plantar fascial fibromatosis) and M77.30 - M77.32 (Calcaneal spur).

AETNA-CPB-0235 — Plantar Fasciitis Treatments

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