Does 36223 require prior authorization?

No, 36223 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 36223?

Medicare facility rate: $297.27. Non-facility rate: $1915.54. Work RVU: 5.61.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

5.61

Facility

$297.27

Non-Facility

$1915.54

Each claim must be submitted with ICD-10-CM code(s) that accurately reflect the patient’s condition and indicate the reason(s) the service was performed.
The medical record must include the ordering/referring provider’s name and NPI for services that require a referring/ordering physician.
The patient’s medical record should include the assessment by the ordering provider related to the patient’s complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports.
For diagnostic tests, report the test result on the claim when known; otherwise report the symptoms that prompted performance of the test.

Cardiac catheterization and coronary angiography are covered when the medical record documents medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests that support the procedure.
Coverage for thoracic aortography and carotid, vertebral, and subclavian angiography is determined by Local Coverage Determination L35035; services are covered when reasonable and necessary per that LCD.
Bill HCPCS code G0278 for femoral or iliac angiography performed at the time of coronary angiography.
Aortography and peripheral angiography are covered when reasonable and necessary per Local Coverage Determination L36767 and when documentation supports the selected ICD-10-CM diagnosis and medical necessity.
Right heart catheterization is indicated to evaluate valvular heart disease.
Right heart catheterization is indicated to evaluate congestive heart failure.

A57056 — Billing and Coding: Aortography and Peripheral Angiography

J09

L36767 — Aortography and peripheral angiography

J09

A56631 — Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

J12

L35035 — Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

J12

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