Does 37213 require prior authorization?

No, 37213 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 37213?

Medicare facility rate: $202.41. Non-facility rate: $202.41. Work RVU: 4.63.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

4.63

Facility

$202.41

Non-Facility

$202.41

When an ABN is issued and liability is being transferred, a signed ABN Form CMS-R-131 must be retained in the beneficiary record; Part A MAC claims require occurrence code 32 and the ABN date.
The medical record must include the ordering provider's assessment related to the patient's complaint for the visit and relevant medical history.
Results of pertinent tests or procedures must be documented; for diagnostic tests, report the test result if known or otherwise the symptoms prompting the test.
Office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.

Claims for dialysis access maintenance billed to Medicare Part A or Part B should be submitted when coding conforms to the applicable Local Coverage Determination L34062 and applicable NCCI and OPPS coding/packaging edits.
For services that require a referring or ordering physician, claims must include the referring/ordering physician's name and NPI to be eligible for payment.
Claims for patients treated for Raynaud's syndrome may be billed in office (11), inpatient hospital (21), outpatient hospital (22), ambulatory surgical center (24), or independent clinic (49).
Transcatheter infusion therapy (report with CPT 61650, 61651, or 37202 as appropriate) is covered when medically necessary to treat vascular conditions requiring intra-arterial medication infusion.
Claims for patients treated for cerebrovasospasm may be submitted (treatment-specific billing) and must be billed with place of service inpatient hospital (21).
Claims for patients treated for bleeding involving the head or neck may be submitted and must be billed with place of service inpatient hospital (21).

A56460 — Billing and Coding: Dialysis Access Maintenance

A56811 — Billing and Coding: Transcatheter Infusion Therapy

L34084 — Transcatheter Infusion Therapy

L34062 — Dialysis Access Maintenance

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