Does 55845 require prior authorization?

No, 55845 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 55845?

Medicare facility rate: $1209.45. Non-facility rate: $1209.45. Work RVU: 24.55.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

24.55

Facility

$1209.45

Non-Facility

$1209.45

No specific documentation requirements, prior authorization criteria, or required clinical documentation are stated in this CPB. (Policy contains literature review, statements of experimental/investigational status, and lists of CPT/HCPCS/ICD-10 codes not covered, but does not specify required documentation fields.)
No documentation requirements specified in this document.
No documentation requirements (medical records, test results, or specific clinical documentation) are specified in the provided text.
In order to determine medical necessity consistently, Humana and subsidiaries may consider the criteria contained in the following: (text indicates additional criteria/documentation will be used but the criteria are not included in this excerpt).

Prompt repair of acute phrenic nerve transection due to trauma or surgery. (Note in policy: "Phrenic nerve reconstruction for the treatment of diaphragmatic paralysis (Note: this does not apply to prompt repair of acute phrenic nerve transection due to trauma or surgery)")
No other specific indications are affirmatively listed as covered in this CPB; multiple nerve grafting and nerve reconstruction interventions are described in the literature review but are explicitly identified in this policy as experimental and investigational (see Limitations).
Radical perineal prostatectomy with lymph node biopsy(s) (limited pelvic lymphadenectomy) — CPT 55812
Open prostatectomy is a surgical procedure where the surgeon removes the prostate through an incision in the lower abdomen or, less commonly, through a perineal incision.
Humana and subsidiaries follow the Medicare requirements that only allow coverage and payment for services that are reasonable and necessary for the diagnosis and treatment of illness or injury or to improve the functioning of a malformed body member except as specifically allowed by Medicare.
Localized prostate cancer (confined to the prostate gland).

HUMANA-PROSTATECTOMY-MA — Prostatectomy - Medicare Advantage

AETNA-CPB-0416 — Nerve Grafting and Reconstruction: Selected Indications

BCBSIL-SUR710.019 — Nerve Graft with Radical Prostatectomy

BCBSMT-SUR710.019 — Nerve Graft with Radical Prostatectomy

BCBSNM-SUR710.019 — Nerve Graft with Radical Prostatectomy

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