61651
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
4.14
Facility
$223.79
Non-Facility
$223.79
Documentation Required
- The patient's medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.
- Medical records must specify medications infused (names and dosages), infusion start and end times, route of administration, vessel infused, and medical indications for the procedure; documentation must be available to Medicare upon request.
- For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- For Part A inpatient hospital claims, the hospital must report the principal diagnosis in UB-04 FL 67 and the admitting diagnosis in FL 69; up to eight additional ICD‑10‑CM codes go in FLs 67A-67Q.
Key Coverage Criteria
- Claims for patients treated for Raynaud's syndrome may be billed in office (11), inpatient hospital (21), outpatient hospital (22), ambulatory surgical center (24), or independent clinic (49).
- Transcatheter infusion therapy (report with CPT 61650, 61651, or 37202 as appropriate) is covered when medically necessary to treat vascular conditions requiring intra-arterial medication infusion.
- Claims for patients treated for cerebrovasospasm may be submitted (treatment-specific billing) and must be billed with place of service inpatient hospital (21).
- Claims for patients treated for bleeding involving the head or neck may be submitted and must be billed with place of service inpatient hospital (21).
- Claims for patients treated for gastrointestinal hemorrhage may be submitted and must be billed with place of service inpatient hospital (21).
- Claims for patients treated for non-occlusive mesenteric ischemia may be submitted and must be billed with place of service inpatient hospital (21).
2 Active Policies
A56811 — Billing and Coding: Transcatheter Infusion Therapy
L34084 — Transcatheter Infusion Therapy
Related Codes
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