Does 28446 require prior authorization?

No, 28446 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 28446?

Medicare facility rate: $1125.61. Non-facility rate: $1125.61. Work RVU: 17.27.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

17.27

Facility

$1125.61

Non-Facility

$1125.61

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage; such documentation does not guarantee coverage.
Referenced guideline titled 'Medical Records Documentation Used for Reviews' for specifics on required documentation.
When deciding coverage, the member specific benefit plan document must be referenced (the member specific plan governs in the event of a conflict).
If applied to Medicare Advantage, determinations may rely on objective evidence-based rationale and applicable Medicare guidance (IOM Pub. No. 100-16, Ch. 4, §90.5); documentation should support applicability of such guidance.

Surgery of the ankle (including arthrodesis, arthroscopy, arthrotomy, and total joint replacement of the ankle) when medically necessary and when the member meets the applicable clinical coverage criteria referenced (InterQual® CP: Procedures: Arthrodesis, Ankle (Talotibial Joint); Arthroscopy, Surgical, Ankle; Arthrotomy, Ankle; Total Joint Replacement (TJR), Ankle).
Ankle surgery to treat osteoarthritis when clinical criteria for surgical intervention are met.
Ankle surgery to treat posttraumatic arthritis when clinical criteria for surgical intervention are met.
Procedures listed in the policy procedure categories (Arthrodesis, Arthroscopy, Arthrotomy, Total Joint Replacement) when the member meets InterQual® clinical criteria (i.e., coverage tied to InterQual® criteria for those procedures).
The member is skeletally mature with documented closure of growth plates (e.g., 15 years or older).
Osteochondral autografts (OATS or mosaicplasty) are considered medically necessary for symptomatic focal full-thickness articular cartilage defects of the knee when ALL of the following criteria are met:

UHC-POL-surgery-ankle — Surgery of the Ankle

UMR-POL-UMR-surgery-ankle — Surgery of the Ankle

SUREST-POL-SUREST-surgery-ankle — Surgery of the Ankle

CARELON-joint-surgery-2024-11-17-updated-2025-01-01 — Joint Surgery

AETNA-CPB-0637 — Osteochondral Autografts (Mosaicplasty, OATS)

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