Does 33285 require prior authorization?

No, 33285 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 33285?

Medicare facility rate: $75.82. Non-facility rate: $4012.12. Work RVU: 1.49.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.49

Facility

$75.82

Non-Facility

$4012.12

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage (refer to the protocol titled Medical Records Documentation Used for Reviews).
Documentation that noninvasive cardiac event recording was attempted and yielded non-diagnostic results after at least two weeks of monitoring, or documentation of contraindication to noninvasive monitoring.
Clinical documentation supporting one or more covered indications (e.g., cryptogenic stroke or other documented systemic thromboembolic event, suspected/known ventricular arrhythmia, high-risk structural or infiltrative heart disease with examples listed in policy, recurrent or unexplained infrequent syncope with documentation of medication modification or association with autonomic dysfunction, or abnormal electrophysiology study/tilt table testing).

Implantable Loop Recorders are proven and medically necessary for evaluating suspected cardiac arrhythmias when noninvasive cardiac event recording is contraindicated or yielded non-diagnostic results after at least two weeks of monitoring in one or more of the following circumstances:
Suspected paroxysmal atrial fibrillation in the setting of a cryptogenic stroke or another documented systemic thromboembolic event
Suspected or known ventricular arrhythmia
High risk for arrhythmia secondary to structural or infiltrative heart disease such as aortic stenosis, hypertrophic cardiomyopathy, cardiac sarcoidosis, congenital heart disease, family history, dilated ischemic or nonischemic cardiomyopathy, or use of medications known to cause malignant arrhythmias such as those prolonging the QT interval
Recurrent or unexplained infrequent syncope, after modification of potentially syncope-causing medications or associated with autonomic dysfunction
Abnormal tests such as electrophysiology study or tilt table testing

AMBETTER-CP.MP.243 — Implantable Loop Recorder

CARELON-ambulatory-cardiac-rhythm-monitoring-2024-07-01 — Ambulatory Cardiac Rhythm Monitoring

UHC-POL-implantable-recorders-wearable-monitors — Implantable Loop Recorders and Wearable Heart Rhythm Monitors

UMR-POL-UMR-implantable-recorders-wearable-monitors — Implantable Loop Recorders and Wearable Heart Rhythm Monitors

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