Does 62258 require prior authorization?

No, 62258 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 62258?

Medicare facility rate: $1105.24. Non-facility rate: $1105.24. Work RVU: 15.25.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

15.25

Facility

$1105.24

Non-Facility

$1105.24

Imaging and laboratory/biomarker data used in studies: brain CT or MRI, amyloid PET (e.g., florbetapir), cerebrospinal fluid (CSF) biomarkers (Aβ1-42, total tau, phospho-tau), and APOE ε4 genotyping when reported in trials.
For some interventional procedures/trials, pre-procedure evaluations included medical/neurological and psychological examinations, depression rating scales (e.g., Montgomery–Asberg Depression Rating Scale), and lumbar puncture with CSF analysis.
Documentation of prior/concurrent standard therapies (e.g., use of cholinesterase inhibitors and/or memantine) is often recorded in trials and may be relevant when considering investigational add-on therapies.
None specified in this policy document. (The CPB lists investigational/experimental treatments and codes not covered; it does not define separate documentation requirements for coverage of the listed items.)

None specified. This Clinical Policy Bulletin addresses experimental treatments for Alzheimer's disease and lists treatments considered experimental and investigational (i.e., not established as effective) for this indication.
No explicit covered indications are stated in this document. The document discusses potential therapeutic use in the following conditions:
Alzheimer's disease (AD)
mild cognitive impairment (MCI)
amnestic MCI
pre-clinical AD

AETNA-CPB-0788 — Alzheimer's Disease: Experimental Treatments

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