Does 33289 require prior authorization?

Yes, 33289 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for 33289?

Medicare facility rate: $284.24. Non-facility rate: $284.24. Work RVU: 5.85.

Verity

`33289`

HCPCS/CPT

Prior Authorization

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Medicare Pricing

Work RVU

5.85

Facility

$284.24

Non-Facility

$284.24

Documentation Required

For home blood pressure monitor coverage: 'the blood pressure cuff is prescribed by a physician.'
CDC statement: 'patients should only use monitors that have been properly validated and tested for accuracy, passing at least 1 accepted standardized international testing protocol. The 3 widely accepted validation protocols are from the Association for the Advancement of Medical Instrumentation (AAMI), the British Hypertension Society (BHS), and the European Hypertension Society (EHS). The CDC noted that not all available home BP monitors have passed these validation tests.' (implies documentation of device validation may be required)
For investigational devices (AngelMed, Chronicle IHM): documentation of investigational status / IDE or trial enrollment is implied by the text: 'The Chronicle IHM has an investigational device exemption in the United States, which allows use of the device in clinical trials.'

Key Coverage Criteria

93280 dual lead pacemaker system
93281 multiple lead pacemaker system
Z99.2 Dependence on renal dialysis
Other CPT codes related to the CPB (listed as related items): 90935 - 90937 Hemodialysis
Aetna considers self-contained pacemaker monitors medically necessary for members with cardiac pacemakers.
Audible/visible signal pacemaker monitors -- these devices produce an audible and visible signal that indicates the pacemaker rate.

8 Active Policies

AMBETTER-CP.MP.160 — Implantable Wireless Pulmonary Artery Pressure Monitoring

CIGNA-0574 — Cardiac Omnibus Codes - (0574)

CIGNA-0574-FUTURE — Cardiac Omnibus Codes - (0574)

HUMANA-TRANSCATHETER-AND-DEVICE-BASED-HEMODYNAMIC-MANAGEMENT-PROCEDURES-MA — Transcatheter and Device-Based Hemodynamic Management Procedures - Medicare Advantage

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33289