Does 69910 require prior authorization?

No, 69910 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 69910?

Medicare facility rate: $874.10. Non-facility rate: $874.10. Work RVU: 13.56.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

13.56

Facility

$874.10

Non-Facility

$874.10

Preoperative and diagnostic test results where applicable: pure tone audiometry (PTA), word recognition scores, caloric testing, cervical/peri‑ocular VEMPs (cVEMP/oVEMP), and other vestibular function testing to document canal paresis or vestibular deficits.
For SSCD: high‑resolution CT of the temporal bone demonstrating dehiscence and supportive VEMP results (lowered thresholds) and clinical documentation of sound/pressure‑induced vertigo or autophony.
Documentation of use of AAO‑HNS diagnostic and treatment criteria in candidate selection (as used in cited studies).
When intra‑tympanic aminoglycoside (gentamicin) is used, documentation that patient was counseled regarding risk of hearing loss and that gentamicin was selected for refractory unilateral disease where benefits outweigh risks.

For the treatment of superior semicircular canal dehiscence if diagnosis is confirmed by audiometry and computed tomography: Middle fossa craniotomy
For the treatment of superior semicircular canal dehiscence if diagnosis is confirmed by audiometry and computed tomography: Trans-mastoid canal plugging
Intra-tympanic / trans-tympanic dexamethasone injection for the treatment of sudden sensorineural hearing loss if members had failed conservative treatments including oral steroids or if members have a medical condition that prohibits the use of oral steroids
CPT codes listed in the CPB are covered if selection criteria are met (see CPT list under 'CPT codes covered if selection criteria are met')
ICD-10 diagnoses covered if selection criteria are met: H81.01 - H81.09 (Meniere's disease [active]); H83.8x1 - H83.8x9 (Other specified diseases of inner ear [superior semicircular canal dehiscence]); H90.3 - H90.A32 (Conductive and sensorineural hearing loss)
Disabling vertigo due to Meniere's disease (MD) in a member who meets the Selection Criteria for Surgery (see below).

AETNA-CPB-0514 — Meniere's Disease and Related Disorders: Surgery

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