Does 46761 require prior authorization?

No, 46761 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 46761?

Medicare facility rate: $830.01. Non-facility rate: $830.01. Work RVU: 14.91.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

14.91

Facility

$830.01

Non-Facility

$830.01

Record of frequency/duration of fecal incontinence demonstrating >2 episodes/week and duration >6 months.
Documentation of prior conservative treatments tried (pharmacotherapy, dietary measures, pelvic floor strengthening) and inadequate response.
Evidence that patient previously achieved bowel control.
Documentation that anal sphincter is structurally intact (clinical exam, imaging, or other objective assessment).

Severe, chronic fecal incontinence defined as >2 incontinent episodes per week on average and duration >6 months.
Failure of adequate conservative treatments (e.g., pharmacotherapy, dietary management, pelvic floor strengthening exercises).
Patient previously achieved bowel control (not congenital loss of bowel control).
Sacral nerve stimulation for a weak but structurally intact anal sphincter when a percutaneous stimulation test produced at least a 50% sustained (>1 week) improvement in symptoms.
Artificial bowel sphincter (Acticon Neosphincter) for adults age ≥ 18 years when all criteria below are met
Failure of, or not a candidate for, medical interventions or surgical sphincter repair

AMBETTER-CP.MP.137 — Fecal Incontinence Treatments

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