Does 37286 require prior authorization?

No, 37286 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 37286?

Medicare facility rate: $618.92. Non-facility rate: $10365.97. Work RVU: 13.46.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

13.46

Facility

$618.92

Non-Facility

$10365.97

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.
Documentation that conservative therapies were tried and failed, including: at least 12 weeks of Supervised Exercise Therapy or a Structured Community-Based Exercise Program; and pharmacologic therapy (e.g., lipid lowering therapy, antihypertensive therapy, antiplatelet therapy, and/or anticoagulants); and smoking cessation counseling/efforts if applicable.
Documentation of impaired ability to work and/or perform activities of daily living (ADL) attributable to Claudication.
Objective perfusion testing showing Ischemic peripheral artery disease with Ankle-Brachial Index (ABI) ≤ 0.90 (ABI < 0.90 indicates PAD).

Endovascular revascularization procedures (e.g., stents, angioplasty, and/or atherectomy) are proven and medically necessary for treating non-limb-threatening lower extremity ischemia in individuals with Claudication due to atherosclerotic disease of the aortoiliac and/or femoropopliteal arteries when all the following criteria are met: - Impaired ability to work and/or perform activities of daily living (ADL); and - All the following conservative therapies have been tried and failed: - At least [...]
Endovascular revascularization procedures (e.g., stents, angioplasty, and/or atherectomy) are proven and medically necessary for treating Chronic Limb Threatening Ischemia (CLTI) with the diagnoses listed under Applicable Codes.

WPS-L35998 — Non-Coronary Vascular Stents

J8 MAC Part B

L40228 — Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities

JJ Part B

PALMETTO-L40228 — Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities

JJ Part B

UHC-POL-lower-endovascular-procedures — Lower Extremity Endovascular Procedures

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