Does 31646 require prior authorization?

No, 31646 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 31646?

Medicare facility rate: $128.93. Non-facility rate: $128.93. Work RVU: 2.71.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

2.71

Facility

$128.93

Non-Facility

$128.93

BMI documentation showing value >15 and <35 kg/m2
Post-bronchodilator spirometry results with recorded FEV1 showing 15-45% predicted
No specific documentation requirements are stated in the provided document excerpt. (The Table of Contents lists a 'Documentation' or similar sections, but required documentation text was not included in this excerpt.)
Documentation that the patient has severe emphysema and continues to have significant signs/symptoms despite maximal medical therapy (medications, pulmonary rehabilitation, smoking cessation) — inferred requirement from the stated indication.

Rule out severe hypoxemia (PaO2 less than or equal to 45 mm Hg) (^{6,10,11})
6-minute walk test of at least 100 m (^{6,10})
Diffusion capacity for carbon monoxide (DLCO) is greater than 20% predicted value at initial evaluation (^{10,11})
Recent completion (within 6 months of initial evaluation) of a supervised pulmonary rehabilitation program (^{10,11})
Placement/use of endobronchial valves for emphysema when the patient meets the (unspecified in this excerpt) clinical selection criteria (referred to as "the criteria above").
Medically reasonable and necessary use of endobronchial valves as determined by meeting the policy's stated criteria (implied by: "The use of the criteria above provides clinical benefits highly likely to outweigh any clinical harms ...").

HUMANA-ENDOBRONCHIAL-VALVES-FOR-EMPHYSEMA-MA — Endobronchial Valves for Emphysema - Medicare Advantage

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