Does 62325 require prior authorization?

No, 62325 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 62325?

Medicare facility rate: $100.87. Non-facility rate: $265.20. Work RVU: 2.15.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

2.15

Facility

$100.87

Non-Facility

$265.20

All documentation must be maintained in the patient's medical record, be legible, include appropriate patient identification (e.g., full name, dates of service), and be available to the contractor upon request.
The medical record must identify the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Medical record must document that the patient is unresponsive to less invasive medical therapy and this documentation must be available upon Medical Review request.

Regional or local nerve blocks performed as part of an operative procedure (e.g., adjunct to or sole means of regional/local anesthesia for the procedure) are not affected by this non-coverage policy and may be billed as anesthesia for the operative procedure.
Implantable infusion pumps are covered when used to administer opioid drugs, alone or in combination with other opioid or non-opioid drugs, via the intrathecal or epidural route.
Covered for treatment of severe chronic intractable pain of malignant or nonmalignant origin when the patient has a life expectancy of at least 3 months.
Coverage requires that the pain is unresponsive to less invasive medical therapy, including systemic opioids, combinations of oral analgesics plus adjuvant pain drugs, or other noninvasive approaches.
The administration must require the intrathecal or epidural route, be expected to be effective on a long-term basis, and oral or subcutaneous medication must be ineffective or cause unacceptable side effects.
An evaluation by an orthopedic surgeon, neurologist, neurosurgeon, oncologist, or other specialist familiar with the underlying disease is required to validate that other treatments have failed and no other reasonable options are available at the time of evaluation.

AMBETTER-CP.MP.164 — Caudal or Interlaminar Epidural Steroid Injections

A55323 — Billing and Coding: Implantable Infusion Pumps for Chronic Pain

A52725 — Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

A55239 — Billing and Coding: Implantable Infusion Pumps for Chronic Pain

A56034 — Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

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