Does 61781 require prior authorization?

No, 61781 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 61781?

Medicare facility rate: $215.10. Non-facility rate: $215.10. Work RVU: 3.66.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.66

Facility

$215.10

Non-Facility

$215.10

No explicit documentation requirements or required clinical record elements are stated in this policy.
When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan.
Before using this policy, check the member specific benefit plan document and any applicable federal or state mandates.
No explicit documentation requirements or a 'Documentation Requirements' section is stated in the CPB.

None — Computer-assisted surgical navigation for musculoskeletal procedures of the pelvis and appendicular skeleton is unproven and not medically necessary due to insufficient evidence of efficacy.
None — The use of an intra-operative sensor for implant stability during knee replacement arthroplasty and for improved knee function post-operatively is unproven and not medically necessary due to insufficient evidence of efficacy.
Pain related to paraplegia / post-paraplegia pain (limited data; some improvement reported in small series)
Complex regional pain syndrome (CRPS) — discussed as experimental in guidelines; case report of combined SCS+MCS as rescue therapy
Pain related to intercostal herpes zoster (single-case reported improvement)
Chronic refractory pain conditions (general) — MCS has been used to treat various chronic refractory pain conditions (text: "Motor cortex stimulation (MCS) has been used to treat various chronic refractory pain conditions such as trigeminal neuralgia, post-stroke pain (PSP), and other nerve/brain injury pain syndromes.")

UHC-POL-computer-assisted-surg-nav-musculoskeletal-procs — Computer-Assisted Surgical Navigation for Musculoskeletal Procedures

AETNA-CPB-0755 — Motor Cortex Stimulation

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