Does 31627 require prior authorization?

No, 31627 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 31627?

Medicare facility rate: $85.17. Non-facility rate: $1155.34. Work RVU: 1.95.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.95

Facility

$85.17

Non-Facility

$1155.34

Documentation of pre-procedure CT imaging used for EN planning (CT scans collected and downloaded into the navigation system's software and 3-dimensional reconstruction) and registration parameters (anatomic landmarks) as described in the procedure background.
Procedure notes describing use of the electromagnetic navigation system (e.g., navigation completed, tissue obtained, use of sensor/extended working channel, fluoroscopy/rEBUS use if applicable) to support coding +31627 / C7509-C7511.
When applicable, documentation of attempted standard bronchoscopic access or reasons why standard bronchoscopy and transthoracic biopsy approaches are not appropriate or feasible for the specific lesion.
Pathology/cytology results obtained from the EN-guided biopsy (or documentation of tissue obtained) to support diagnostic intent and medical necessity.

ICD-10 covered diagnoses (when selection criteria are met): R91.1 Solitary pulmonary nodule [peripheral pulmonary nodule]; R91.8 Other nonspecific abnormal finding of lung field [peripheral pulmonary nodules].
CPT/HCPCS codes considered covered when selection criteria are met: +31627 (Bronchoscopy ... with computer-assisted, image-guided navigation); HCPCS C7509, C7510, C7511 (computer-assisted image-guided navigation bronchoscopy codes for diagnostic/cell washing, BAL, and biopsy respectively).
Aetna considers electromagnetic navigation (EN)-guided bronchoscopy medically necessary for individuals with a peripheral pulmonary nodule that requires a pathologic diagnosis and is not accessible by standard bronchoscopy methods or by a transthoracic biopsy approach.
CPT: +31627 — Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s]) (listed as covered if selection criteria are met)
HCPCS: C7509 — Bronchoscopy, rigid or flexible, diagnostic with cell washing(s) when performed, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed (covered if selection criteria are met)
HCPCS: C7510 — Bronchoscopy, rigid or flexible, with bronchial alveolar lavage(s), with computer-assisted image-guided navigation, including fluoroscopic guidance when performed (covered if selection criteria are met)

AETNA-CPB-0776 — Electromagnetic Navigation-Guided Bronchoscopy

ANTHEM-CG-MED-93 — CG-MED-93 Navigational Bronchoscopy

REGENCE-SUR179 — Electromagnetic Navigation Bronchoscopy

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