Does 47999 require prior authorization?

No, 47999 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 47999?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

A specific written report describing the service, item or supply provided when an unlisted code is billed.
An invoice for unlisted or miscellaneous items or supplies, when applicable, to determine coverage.
Documentation must state whether the service was provided independent from other services and whether it was performed at the same site or through the same surgical opening.
Medical records demonstrating medical necessity, including documentation that the service is required to diagnose or treat an illness/injury/disease or its symptoms, is in accordance with generally accepted standards of medical practice, and is clinically appropriate in type, frequency, extent, site and duration.

Use of an unlisted CPT or HCPCS code when there is an absence of an available CPT or HCPCS procedure code that accurately describes the service.
Procedure that is entirely new, unproven, or potentially investigational (when an appropriate unlisted code is used and criteria are met).
An established procedure performed by a different method or approach (when an appropriate unlisted code is used and criteria are met).
An established procedure using a different device than described by standard available codes (when an appropriate unlisted code is used and criteria are met).
A procedure performed at a different anatomical location than described in standard available codes (when an appropriate unlisted code is used and criteria are met).
Medical necessity for the unlisted code established by supporting documentation, including a specific written report describing the service and, when applicable, an invoice for unlisted/miscellaneous items or supplies.

CARELON-radiation-therapy-excludes-proton-2025-03-23 — Radiation Therapy Excludes Proton

CIGNA-0583 — Unlisted Procedure Codes - (0583)

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