Does 36513 require prior authorization?

No, 36513 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 36513?

Medicare facility rate: $88.18. Non-facility rate: $88.18. Work RVU: 1.95.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.95

Facility

$88.18

Non-Facility

$88.18

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage but does not guarantee coverage of the service requested; refer to the protocol titled Medical Records Documentation Used for Reviews.
Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service.
When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan. In the event of a conflict, the member specific benefit plan document governs.
UnitedHealthcare may use third party tools (e.g., InterQual® criteria) to assist in administering benefits; additional documentation may be required per those tools or the Medical Records Documentation Used for Reviews protocol.

Multiple sclerosis, acute attack, or relapse, second line therapy
Myasthenia gravis, acute
Myeloma cast nephropathy, second line therapy
Lipoprotein(a) hyperlipoproteinemia
Acute inflammatory demyelinating polyneuropathy, primary treatment
Acute liver failure [requiring high volume therapeutic plasma exchange (TPE-HV)]

UHC-POL-apheresis — Apheresis

UMR-POL-UMR-apheresis — Apheresis

SUREST-POL-SUREST-apheresis — Apheresis

ANTHEM-CG-MED-68 — CG-MED-68 Therapeutic Apheresis

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