Does 50328 require prior authorization?

No, 50328 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 50328?

Medicare facility rate: $170.01. Non-facility rate: $170.01. Work RVU: 3.41.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.41

Facility

$170.01

Non-Facility

$170.01

Refer to separate policy CP.MP.250 for criteria related to Lantidra (donislecel) allogeneic pancreatic islet cellular therapy.
Serial blood and urine testing may be required to verify abstinence from substances of concern.
Documentation of a commitment to reduce substance-use behaviors is acceptable when urgent transplant timelines exist (as evidence of risk-reduction intent).
Chart notes, emergency department records, or hospitalization records documenting the recurrent severe metabolic complications and specifying the type (e.g., hypoglycemia unawareness, severe hypoglycemic attacks, marked hyperglycemia, recurrent ketoacidosis).

AMBETTER-CP.MP.102 — Pancreas Transplantation

AMBETTER-CP.MP.246 — Pediatric Kidney Transplant

ANTHEM-GL-A051131 — Status

ANTHEM-MP-A046252 — Pre-Merger Organizations

BCBSIL-SUR703.007 — Kidney Transplant

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