Does 61791 require prior authorization?

No, 61791 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 61791?

Medicare facility rate: $1126.61. Non-facility rate: $1126.61. Work RVU: 15.02.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

15.02

Facility

$1126.61

Non-Facility

$1126.61

When billing, providers must use the most appropriate codes as of the effective date of the submission. Claims submitted for services that are not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered.
For trigeminal neuralgia, documentation should support that the condition is refractory to other alternative treatments (e.g., medication, microdecompression) as the policy specifies radiofrequency ablation or glycerol rhizotomy is medically necessary only for trigeminal neuralgia refractory to other treatments.
No additional explicit step-by-step documentation checklist (e.g., required diagnostic test results or exact prior treatment durations) is provided in the excerpt; reviewers are directed to consider the terms of the applicable benefit plan document, applicable laws/regulations, collateral source materials including Coverage Policies, and the specific facts of each case.

Peripheral nerve destruction using radiofrequency ablation or glycerol rhizotomy is considered medically necessary for treatment of trigeminal neuralgia refractory to other alternative treatments (e.g., medication, microdecompression).
Considered medically necessary when criteria in the applicable policy statements listed above are met: CPT 61790; CPT 61791; CPT 64600; CPT 64605; CPT 64610.
Radiofrequency (RF) neurolysis is consideredmedically necessaryfor individuals with trigeminal neuralgia who do not respond to or cannot tolerate medical therapy.

CIGNA-0525 — Peripheral Nerve Destruction for Pain Conditions - (0525)

ANTHEM-CG-SURG-89 — CG-SURG-89 Radiofrequency Neurolysis and Pulsed Radiofrequency Therapy for Trigeminal Neuralgia

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