Does 44120 require prior authorization?

No, 44120 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 44120?

Medicare facility rate: $1136.30. Non-facility rate: $1136.30. Work RVU: 20.30.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

20.30

Facility

$1136.30

Non-Facility

$1136.30

Documentation of individual compliance with medical management
Medical record documentation demonstrating intestinal failure (cause and inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance)
Documentation of adequate cardiopulmonary status (clinical assessment/results)
Clinical documentation demonstrating intolerance of TPN, such as records of multiple or prolonged hospitalizations for TPN-related complications.

Small bowel-liver transplant or multivisceral transplant for pediatric and adult individuals with intestinal failure characterized by loss of absorption and inability to maintain protein-energy, fluid, electrolyte, or micronutrient homeostasis.
Small bowel/liver transplant or multivisceral transplant is medically necessary for patients managed with long-term total parenteral nutrition (TPN) who have developed evidence of impending end-stage liver failure.
Small bowel/liver retransplant or multivisceral retransplant is medically necessary after a failed primary small bowel/liver transplant or multivisceral transplant.
Intestinal failure due to surgical resection, congenital defect, or disease-associated loss of absorption characterized by inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance
Short bowel syndrome as an example of intestinal failure
Candidates must have adequate cardiopulmonary status

BCBSIL-SUR703.009 — Small Bowel/Liver and Multivisceral Transplant

BCBSMT-SUR703.009 — Small Bowel/Liver and Multivisceral Transplant

BCBSNM-SUR703.009 — Small Bowel/Liver and Multivisceral Transplant

BCBSOK-SUR703.009 — Small Bowel/Liver and Multivisceral Transplant

SUR703.009 — Small Bowel/Liver and Multivisceral Transplant

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