Does 47142 require prior authorization?

No, 47142 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 47142?

Medicare facility rate: $4375.52. Non-facility rate: $4375.52. Work RVU: 77.45.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

77.45

Facility

$4375.52

Non-Facility

$4375.52

Evidence of risk-reduction behaviors for substance use when claiming exemption from exclusion.
Serial blood and urine testing may be used to verify abstinence from substances of concern.
If urgent transplant timelines, documentation of the patient's commitment to reduce/cease substance use.
Multidisciplinary pre-transplant evaluation documenting clinical necessity and assessment of psychosocial, neurocognitive, and developmental needs.

Autoimmune hepatitis
Toxin exposure: Amanita mushroom poisoning
Note: Members must meet the disease specific criteria as well as the general Individual Selection Criteria below for the transplantation to be considered medically necessary.
Medically Necessary:A whole or partial liver transplant using a deceased or living donor is consideredmedically necessaryfor selected individuals with end-stage organ failure due to irreversible liver damage that includes, but is not limited to, the following conditions:
Cholestatic liver diseases:Primary biliary cirrhosisPrimary sclerosing cholangitisBiliary atresiaCaroli's diseaseFamilial cholestasisArteriohepatic dysplasia (Alagaille's disease)Cystic Fibrosis
Primary biliary cirrhosis

AMBETTER-CP.MP.120 — Pediatric Liver Transplant

ANTHEM-MP-A053525 — TRANS.00008 Liver Transplantation

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

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