Does 64657 require prior authorization?

No, 64657 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for 64657?

Medicare facility rate: $632.28. Non-facility rate: $632.28. Work RVU: 12.13.

Verity

`64657`

HCPCS/CPT

Prior Authorization

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Medicare Pricing

Work RVU

12.13

Facility

$632.28

Non-Facility

$632.28

Documentation Required

No documentation requirements are specified in the provided excerpt (no required medical records, test results, or clinical documentation listed).
Documentation that the individual remains symptomatic despite treatment with optimal medical therapy.
Record of left ventricular ejection fraction (LVEF) measurement showing LVEF ≤35%.
Documentation of New York Heart Association (NYHA) functional class (must be Class II or III).

Key Coverage Criteria

Implantable carotid sinus baroreflex activation system (Barostim Neo) purported to treat resistant hypertension (RHT).
Implantable carotid sinus baroreflex activation system (Barostim Neo) purported to treat heart failure (HF) in an individual with reduced ejection fraction (i.e., heart failure with reduced ejection fraction).
Baroreflex activation therapy (BAT) as delivered by the Barostim Neo (described as delivering electric current to baroreceptors in the carotid sinus to initiate systemic blood pressure lowering responses and to enable the heart to increase output).
Referenced Medicare national coverage determination: Implantable Pulmonary Artery Pressure Sensors for Heart Failure Management (NCD 20.36) — listed in the document header/table.
Referenced National Coverage Analysis (NCA): Renal Denervation for Uncontrolled Hypertension (CAG-00470N) — listed in the document header/table.
The Barostim Neo is US Food & Drug Administration (FDA) approved for the treatment of HF symptoms, including functional status for an individual that remains symptomatic despite treatment with optimal medical therapy.

3 Active Policies

HUMANA-TRANSCATHETER-AND-DEVICE-BASED-HEMODYNAMIC-MANAGEMENT-PROCEDURES-MA — Transcatheter and Device-Based Hemodynamic Management Procedures - Medicare Advantage

ANTHEM-SURG.00124 — SURG.00124 Carotid Sinus Baroreceptor Stimulation Devices

REGENCE-SUR183 — Baroreflex Stimulation Devices

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64657