Does 42550 require prior authorization?

No, 42550 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 42550?

Medicare facility rate: $52.11. Non-facility rate: $146.96. Work RVU: 1.22.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.22

Facility

$52.11

Non-Facility

$146.96

Retain and provide copies of hard-copy output with analysis of all data (including bidirectional vascular flow or imaging when provided) in the patient record.
Document clinical findings (e.g., signs/symptoms) and clinical decision rules (Wells score) supporting the medical necessity for the ultrasound.
For outpatient non-active cancer patients with Wells score <2, include the positive D-dimer result in the record prior to performing ultrasound.
For follow-up ultrasounds in patients on therapy, document the clinical change and rationale showing how change in thrombus burden will alter treatment.

Perform peripheral venous ultrasound to evaluate clinical signs or symptoms suggestive of acute or new-onset deep vein thrombosis (e.g., extremity swelling, tenderness, erythema).
Perform venous ultrasound to investigate DVT as the source of a confirmed pulmonary embolism.
Repeat or perform venous ultrasound for patients with known venous thrombosis who have a clinical change and where documented change in thrombus burden would alter management or therapy.
Perform venous ultrasound to evaluate postthrombotic (postphlebitic) syndrome in patients with symptoms consistent with PTS (e.g., chronic leg pain, heaviness, swelling, itching, or leg ulcers).
Perform venous ultrasound to evaluate suspected valvular incompetence in patients with symptomatic chronic venous insufficiency or symptomatic varicose veins when the result will confirm diagnosis prior to treatment.
Perform venous ultrasound for post-procedural assessment following venous ablation to evaluate treatment outcome or complications.

L33693 — Peripheral Venous Ultrasound

J09

L35007 — Vestibular and Audiologic Function Studies

J12

A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)

J12

L35451 — Peripheral Venous Ultrasound

J12

L35434 — Oximetry Services

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