Does 37238 require prior authorization?

No, 37238 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 37238?

Medicare facility rate: $270.88. Non-facility rate: $3274.62. Work RVU: 5.89.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

5.89

Facility

$270.88

Non-Facility

$3274.62

Providers must follow NCCI edits and Medicare coding guidelines and consult NCCI for correct code combinations prior to billing.
When catheterization or exposure is performed by the same physician who performed the primary endovascular repair, append modifier -51 to the appropriate catheterization/exposure code on the claim.
When endovascular repair is performed by cooperating physicians each should report the appropriate repair code and append modifier -62 (co-surgeons) or modifier -80 (assistant surgeon) as applicable.
When reporting reduced services with modifier -52, submit supporting documentation or explanation with the claim.

Endovascular repair of an abdominal aortic and/or iliac artery aneurysm is covered when billed with CPT codes 34701-34708.
Endovascular repair for acute aortic or iliac artery rupture (clinical and/or radiographic evidence of acute hemorrhage) is covered with CPT codes 34702, 34704, 34706, or 34708.
Endovascular repair for contained/stable or chronic ruptures (pseudoaneurysms) is covered with CPT codes 34701, 34703, 34705, or 34707.
Endovascular repair of descending thoracic aortic aneurysms or replacement is covered using appropriate thoracic CPT codes (e.g., 33880-33891) and associated catheter/imaging codes as applicable.
Placement of an iliac branched endograft is covered: CPT 34717 (add-on) when reported with 34703/34704/34705/34706 (once per side) or CPT 34718 as a standalone code (use modifier -50 for bilateral 34718).
Open arterial exposure required for endograft delivery in small-diameter vessels is covered and reported using the appropriate add-on exposure CPT codes (e.g., 34812, 34820, 34833, 34834, 34714, 34715, 34716).

L35998 — Non-Coronary Vascular Stents

J05

A57590 — Billing and Coding: Non-Coronary Vascular Stents

J05

L38231 — Endovenous Stenting

J09

A56644 — Billing and Coding: Endovenous Stenting

J09

A53124 — Billing and Coding: Endovascular Repair of Aortic and/or Iliac Aneurysms

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