Does 38225 require prior authorization?

No, 38225 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for 38225?

Medicare facility rate: $83.50. Non-facility rate: $83.50. Work RVU: 1.89.

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Work RVU

1.89

Facility

$83.50

Non-Facility

$83.50

"Humana and subsidiaries follow the Medicare requirements that only allow coverage and payment for services that are reasonable and necessary for the diagnosis and treatment of illness or injury" (i.e., medical necessity must be documented).
"Humana and subsidiaries apply a Medicare Administrative Contractor's (MAC's) LCD to all requests (both Part A and Part B services) within the MAC's applicable geographic jurisdiction." (Documentation should meet the applicable MAC LCD/NCD requirements.)
For autologous stem cell harvest and short-term storage in multiple myeloma: "the treating physician documents that a future transplant is highly likely."
Requests for allogeneic hematopoietic cell transplantation for primary refractory or relapsed Hodgkin and non-Hodgkin lymphoma with B-cell or T-cell origin must meet the criteria contained in the referenced CMS Local Coverage Determinations (L39396, L39398, L39270, L39434, L39477, L39513) — documentation should satisfy those LCD criteria.

Multiple myeloma (stem cell transplantation referenced under CMS NCD 110.23)
Neuroblastoma (stem cell transplantation referenced under CMS NCD 110.23)
Non-Hodgkin's lymphoma (stem cell transplantation referenced under CMS NCD 110.23)
Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) for: Aplastic anemia
Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) for: Leukemia
Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) for: Myelodysplastic syndromes (MDS)

HUMANA-CHIMERIC-ANTIGEN-RECEPTOR-CAR-T-CELL-THERAPY-MA — Chimeric Antigen Receptor (CAR) T-cell Therapy - Medicare Advantage

HUMANA-HEMATOPOIETIC-STEM-CELL-TRANSPLANTATION-MA — Hematopoietic Stem Cell Transplantation - Medicare Advantage

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