Does 36012 require prior authorization?

No, 36012 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 36012?

Medicare facility rate: $153.64. Non-facility rate: $808.30. Work RVU: 3.42.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.42

Facility

$153.64

Non-Facility

$808.30

For repeat uterine artery embolization: documentation of continued symptoms such as bleeding or pain.
For repeat uterine artery embolization: imaging demonstrating an incomplete initial procedure, specifically continued blood flow to treated regions.
For ovarian/internal iliac vein embolization for PCS: documentation in the medical record that all required clinical and imaging criteria for PCS have been met (specific criteria to be provided elsewhere in the policy).
Documented duration of continuous CPP ≥6 months and impact on activities of daily living

Uterine artery embolization for uterine fibroids (leiomyomata) with excessive uterine bleeding: profuse bleeding lasting more than 8 days or anemia due to acute or chronic blood loss.
Uterine artery embolization for uterine fibroids causing pelvic discomfort: acute severe pain, chronic lower abdominal pain, low back pressure, or bladder pressure with urinary frequency not due to urinary tract infection.
Uterine artery embolization for asymptomatic fibroids that are palpable abdominally and are of concern to the patient.
Uterine artery embolization as treatment for postpartum hemorrhage.
Testicular (gonadal) vein embolization for treatment of symptomatic varicocele.
One repeat transcatheter therapeutic embolization or vessel occlusion of the uterine arteries for persistent symptoms of uterine fibroids after an initial uterine artery embolization when there is documented continued symptoms (e.g., bleeding or pain) and imaging demonstrates an incomplete initial procedure with continued blood flow to the treated regions.

SUR701.015 — Therapeutic Embolization and Vessel Occlusion to Treat Pelvic Conditions

BCBSIL-SUR701.015 — Therapeutic Embolization and Vessel Occlusion to Treat Pelvic Conditions

BCBSMT-SUR701.015 — Therapeutic Embolization and Vessel Occlusion to Treat Pelvic Conditions

BCBSNM-SUR701.015 — Therapeutic Embolization and Vessel Occlusion to Treat Pelvic Conditions

BCBSOK-SUR701.015 — Therapeutic Embolization and Vessel Occlusion to Treat Pelvic Conditions

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