Does 50542 require prior authorization?

No, 50542 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 50542?

Medicare facility rate: $1044.78. Non-facility rate: $1044.78. Work RVU: 20.83.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

20.83

Facility

$1044.78

Non-Facility

$1044.78

Benign cytology ononefine needle or core biopsy;and
Whole-gland cryosurgical ablation of the prostate is consideredmedically necessaryas a treatment of prostate cancer.
Thermal ablation (radiofrequency ablation, cryoablation or microwave ablation) of NSCLC is consideredmedically necessarywhen all of the following criteria are met:
Surgical or radiation treatment with curative intent is considered appropriate based on stage of disease, however medical co-morbidity renders the individual unfit for those interventions;and
No tumor has a maximum diameter of greater than 3.0 cm;and
Tumors are located at least 1 cm from the trachea, main bronchi, esophagus, aorta, aortic arch branches, pulmonary artery and the heart.

ANTHEM-CG-SURG-61 — CG-SURG-61 Cryosurgical, Radiofrequency, Microwave or Laser Ablation to Treat Solid Tumors Outside the Liver

REGENCE-SUR132 — Cryosurgical Ablation of Miscellaneous Solid Tumors Outside of the Liver

REGENCE-SUR132a — Cryosurgical Ablation of Miscellaneous Solid Tumors Outside of the Liver

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