Does 64738 require prior authorization?

No, 64738 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64738?

Medicare facility rate: $416.18. Non-facility rate: $416.18. Work RVU: 6.20.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

6.20

Facility

$416.18

Non-Facility

$416.18

the procedure is reasonably expected to improve the functional impairment;and
an audiogram documents a loss of at least 15 decibels in the affected ear(s).
Facial plastic surgery is consideredmedically necessarywhen required tocorrect a significant functional impairmentandthe procedure can be reasonably expected to improve the functional impairment. Examples include, but are not limited to, reconstructive procedures which correct or improve a significant functional impairment of speech, nutrition, control of secretions, protection of the airway, or corneal protection.
Facial plastic surgery is consideredreconstructivewhen intended to address a significant variation from normal related to accidental injury, disease, trauma, or treatment of a disease or congenital defect.Note:The initial restoration may be completed in stages.
Otoplasty is consideredmedically necessarywhen performed to surgically correct a physical structure or absence of a physical structure that is causing hearing loss, or intended to facilitate the use of a hearing aid or device whenbothof the following criteria are met:
Otoplasty is consideredreconstructivewhen intended to restore a significantly abnormal external ear or auditory canal related to accidental injury, disease, trauma, or treatment of a disease or congenital defect.

ANTHEM-MP-A050276 — ANC.00008 Cosmetic and Reconstructive Services of the Head and Neck

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