Does 67500 require prior authorization?

No, 67500 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 67500?

Medicare facility rate: $55.11. Non-facility rate: $78.83. Work RVU: 1.15.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.15

Facility

$55.11

Non-Facility

$78.83

Diagnosis documentation of post-herpetic neuralgia (PHN) — clinical diagnosis typically from 'typical unilateral dermatomal pain and rash' and PHN defined in background as 'significant pain or dysaesthesia present 3 months or more following HZ.'
When billing CPT/HCPCS codes listed as 'covered if selection criteria are met,' documentation must demonstrate that the applicable selection criteria are met (policy: 'CPT codes / HCPCS codes / ICD-10 codes — CPT codes covered if selection criteria are met').
For use of Qutenza (capsaicin 8% patch): documentation that the patch was applied by a health care professional, the most painful skin areas treated, number of patches used (up to 4), duration of application (60 minutes), and monitoring for at least 1 hour post-application due to blood pressure risk ('Qutenza must be applied to the skin by a health care professional... The patient must also be monitored for at least 1 hour...').

Post-herpetic neuralgia (PHN).
Aetna considers the use of antivirals (oral), gabapentin, intrathecal, interlaminar or transforaminal epidural corticosteroids, lidocaine patch, opioids (oral), pregabalin, and tricyclic anti-depressants medically necessary for post-herpetic neuralgia (PHN).
CPT/HCPCS codes listed in the policy are covered if selection criteria are met (see 'CPT Codes / HCPCS Codes / ICD-10 Codes' section).
ICD-10 codes B02.21 - B02.29 (Zoster [herpes zoster] with other nervous system involvement) are listed as covered diagnoses if selection criteria are met.
Inferred: Postherpetic neuralgia (PHN) — multiple citations focus on treatment and prevention of PHN.
Inferred: Acute herpes zoster (shingles) and zoster-related pain — citations include trials and prevention strategies.

AETNA-CPB-0725 — Post-Herpetic Neuralgia

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