Does 63032 require prior authorization?

No, 63032 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 63032?

Medicare facility rate: $136.28. Non-facility rate: $136.28. Work RVU: 2.50.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

2.50

Facility

$136.28

Non-Facility

$136.28

Member-specific benefit plan document must be referenced when deciding coverage; '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.' (Instructions for Use)
Informational (FDA PMA language): For Barricaid® (PMA), indication requires confirmation 'by history, physical examination and imaging studies which demonstrate neural compression using MRI' and that the device is used 'to treat a large annular defect (between 4-6 mm tall and between 6-10 mm wide) following a primary discectomy procedure at a single level between L4 and S1.' (U.S. Food and Drug Administration section)
Applicable codes and coding lists are provided for reference only and do not establish coverage; documentation should support medical necessity per the member's benefit plan and any applicable federal/state mandates. (Applicable Codes / Instructions for Use)

None — this Medical Policy states the following procedures are unproven and not medically necessary due to insufficient evidence of efficacy: Annular closure devices (ACDs); Percutaneous injection of allogeneic cellular/tissue-based products; Thermal intradiscal procedures (TIPs) for treating discogenic pain. (Coverage Rationale)
Note (informational, not a payer coverage determination): FDA premarket approval (PMA) for the Barricaid® Annular Closure Device is described in the document: 'indicated for reducing the incidence of reherniation and reoperation in skeletally mature patients with radiculopathy (with or without back pain) attributed to a posterior or posterolateral herniation, and confirmed by history, physical examination and imaging studies which demonstrate neural compression using MRI to treat a large annular [...]

UHC-POL-discogenic-pain-treatment — Discogenic Pain Treatment

UMR-POL-UMR-discogenic-pain-treatment — Discogenic Pain Treatment

SUREST-POL-SUREST-discogenic-pain-treatment — Discogenic Pain Treatment

REGENCE-SUR243 — Annular Closure Devices

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