Does 46601 require prior authorization?

No, 46601 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 46601?

Medicare facility rate: $85.51. Non-facility rate: $166.00. Work RVU: 1.56.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.56

Facility

$85.51

Non-Facility

$166.00

Medical record documentation must support abnormal findings on anoscopy to justify HRA (describe lesion/location/visual findings).
Medical record documentation must support abnormal findings on DRE to justify HRA (describe mass/lesion/abnormality).
Medical record documentation of prior HPV-related anal disease (history of anal squamous dysplasia, prior positive HPV testing, or prior anal intraepithelial neoplasia) is required to justify HRA.
Anorectal cytology report showing abnormalities must be available in the medical record to justify HRA.

High-resolution anoscopy (HRA) is covered for patients with abnormalities detected on anoscopy.
HRA is covered for patients with abnormalities on digital rectal examination (DRE).
HRA is covered for patients with a history of HPV-related anal disease or anal squamous dysplasia.
HRA is covered for patients with abnormalities in anorectal cytology.

A59323 — Billing and Coding: High Resolution Anoscopy

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