Does 49320 require prior authorization?

No, 49320 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 49320?

Medicare facility rate: $316.31. Non-facility rate: $316.31. Work RVU: 5.01.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

5.01

Facility

$316.31

Non-Facility

$316.31

Hysteroscopy is consideredmedically necessaryin the evaluation of infertility for any of the following indications:
Suspected uterine abnormality as evidenced by abnormal hysterosalpingogram or hysterosonogram (for example, but not limited to endometrial polyp, submucosal myoma, intrauterine synechia (scarring) or uterine anomaly (unicornuate, bicornuate, septate uteri);or
Proximal tubal occlusion on hysterosalpingogram;or
Cervical stenosis;or
Inadequate or non-diagnostic hysterosalpingogram or sonohysterogram.

ANTHEM-CG-SURG-34 — CG-SURG-34 Diagnostic Hysteroscopy for Infertility

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