46607
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
2.15
Facility
$113.23
Non-Facility
$230.80
Documentation Required
- 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.
Key Coverage Criteria
- 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.
1 Active Policy
A59323 — Billing and Coding: High Resolution Anoscopy
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.