Does 46707 require prior authorization?

No, 46707 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 46707?

Medicare facility rate: $513.37. Non-facility rate: $513.37. Work RVU: 6.23.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

6.23

Facility

$513.37

Non-Facility

$513.37

ChronOS / TCP with bone marrow studies: documentation of diagnosis (benign cystic bone lesion type: non-ossifying fibroma, enchondroma, fibrous dysplasia, aneurysmal bone cyst, juvenile bone cyst), operative records showing mixing of ChronOS granules with autologous bone marrow harvested during surgery, and radiographic follow-up using Neer classification for bone regeneration.
For antibiotic bead local therapy (calcium sulfate beads): operative notes documenting debridement and bead placement, systemic antibiotic regimen, culture results, and follow-up documentation of wound status (presence/character of wound discharge) and radiographic dissolution of beads (authors reported beads dissolved at average ~36 days).
For INFUSE lumbar fusion: documentation that 'The member meets medical necessity criteria for lumbar spinal fusion in CPB 0743 - Spinal Surgery: Laminectomy and Fusion' and that 'INFUSE Bone Graft is to be implanted via an anterior (ALIF) or lateral (OLIF, DLIF, XLIF or LLIF) approach.'

AETNA-CPB-0411 — Bone and Tendon Graft Substitutes and Adjuncts

BCBSIL-SUR709.032 — Plugs for Anal Fistula Repair

BCBSMT-SUR709.032 — Plugs for Anal Fistula Repair

BCBSNM-SUR709.032 — Plugs for Anal Fistula Repair

BCBSOK-SUR709.032 — Plugs for Anal Fistula Repair

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