Does 48160 require prior authorization?

No, 48160 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 48160?

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

No explicit documentation requirements (medical records, test results, or clinical notes) are stated in the provided document text.
Documentation of type 1 diabetes diagnosis (inferred requirement).
Documentation of difficulty controlling blood glucose despite conventional therapy (multiple daily insulin injections or insulin pump and glucose monitoring) (inferred requirement).
Documented diagnosis of Type 1 Diabetes (T1D).

Patients with T1D whose severe hypoglycemia episodes negatively impact quality of life, require hospitalization, or put them at risk of death (inferred from text).
Treatment of T1D (Type 1 Diabetes) with an allogenic (deceased donor) pancreatic islet cellular therapy.
Indicated for adults with T1D who are unable to approach target glycated hemoglobin (average blood glucose levels) because of current repeated episodes of severe hypoglycemia (low blood sugar) despite intensive diabetes management and education.
Lantidra (donislecel) cell therapy is given as a single infusion into the hepatic portal vein.
The infusion may be repeated if the initial dose is inadequate. ("which may be repeated* if the initial dose is inadequate.")
Humana members may be eligible under the Plan for Lantidra (donislecel) when the following criteria are met. (Note: specific eligibility criteria are referenced but not included in this excerpt.)

AMBETTER-CP.MP.102 — Pancreas Transplantation

HUMANA-LANTIDRA-DONISLECEL-SC-MEDICAID — Lantidra (donislecel) - MEDICAID - SOUTH CAROLINA

ANTHEM-MP-A053822 — TRANS.00010 Autologous and Allogeneic Pancreatic Islet Cell Transplantation

BCBSIL-SUR703.057 — Islet Transplantation for Chronic Pancreatitis and Donislecel-jujn for Type 1 Diabetes

BCBSMT-SUR703.057 — Islet Transplantation for Chronic Pancreatitis and Donislecel-jujn for Type 1 Diabetes

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