64721
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
4.85
Facility
$423.19
Non-Facility
$482.64
Documentation Required
- No specific documentation requirements are provided in this document excerpt.
- Documentation of diagnosis of CTS (clinical symptoms consistent with median nerve compression at the wrist — pain, weakness, numbness).
- Documentation of a trial of conservative therapy and its lack of success prior to surgery — e.g., records showing rest/activity modification, splinting, NSAID/oral steroid use and/or corticosteroid injection(s) with persistent symptoms.
- While the document references associated conditions (pregnancy, diabetes, rheumatoid arthritis, thyroid disease), it does not state specific additional documentation requirements for these comorbidities.
Key Coverage Criteria
- Endoscopic carpal tunnel release (uses a small flexible tube with a camera; surgeon views the ligament through the camera).
- Carpal tunnel syndrome (CTS) defined as compression of the median nerve at the wrist presenting with pain, weakness and/or numbness in the hand and wrist, radiating up the arm.
- CTS associated with pregnancy.
- CTS associated with diabetes.
- CTS associated with rheumatoid arthritis.
- CTS associated with thyroid disease.
2 Active Policies
HUMANA-CARPAL-TUNNEL-SYNDROME-SURGICAL-TREATMENTS-MA — Carpal Tunnel Syndrome Surgical Treatments - Medicare Advantage
ANTHEM-CG-SURG-112 — CG-SURG-112 Carpal Tunnel Decompression Surgery
Related Codes
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