Does 36680 require prior authorization?

No, 36680 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 36680?

Medicare facility rate: $57.78. Non-facility rate: $57.78. Work RVU: 1.17.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.17

Facility

$57.78

Non-Facility

$57.78

Functional outcome measures: pre- and post-operative scores such as Modified Harris Hip Score (MHHS) and Visual Analog Scale (VAS) (used to document clinical improvement in studies).
Detailed documentation of BMAC/BMDCT procedures: harvest technique, preparation method, cellular characterization/quality of the BMAC (authors note inconsistent reporting and recommend following consensus guidelines).
Procedure-specific details for adjuvants: if intraosseous ibandronate used, document technique, dose/administration and safety monitoring (Kumar et al. 2021 reported technique and safety in their small series).
Imaging documentation of baseline and follow-up radiographic progression (to support assessment of progression-free survival and collapse).

“When bilateral core decompression is indicated, it can be done simultaneously on both hips...”
Aetna considers core decompression medically necessary for the treatment of early/pre-collapse (stage I or II; before X-ray changes are evident) avascular necrosis of the hip (femoral head and/or neck).
HCPCS code S2325 (Hip core decompression) — covered if selection criteria are met.
Core decompression (CD) for management of pre-collapse stage of ONFH.
Adjunctive approaches for early (pre-collapse) femoral head osteonecrosis that are repeatedly discussed as treatment options (with varying evidence): "core decompression combined with bone grafting", "core decompression and implantation of autologous BMMC/BMSCs/bone marrow cells", "core decompression combined with PRP/PRF/platelet concentrates", "core decompression with synthetic bone graft substitute (calcium sulfate and calcium phosphate)", "core decompression combined with bone morphogenetic [...]
Pre-collapse stage of osteonecrosis of the femoral head (ONFH)

AETNA-CPB-0753 — Core Decompression for Avascular Necrosis

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