Does 71260 require prior authorization?

Yes, 71260 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for 71260?

Medicare facility rate: $5.74. Non-facility rate: $5.74. Work RVU: 1.13.

HCPCS/CPT

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Work RVU

1.13

Facility

$5.74

Non-Facility

$5.74

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
Claims must meet the reasonable and necessary documentation requirements specified in LCD L35391; refer to that LCD for required medical record elements and prior authorization rules.
Retain and provide copies of hard-copy output with analysis of all data (including bidirectional vascular flow or imaging when provided) in the patient record.
Document clinical findings (e.g., signs/symptoms) and clinical decision rules (Wells score) supporting the medical necessity for the ultrasound.

Multiple imaging studies in oncology are covered only when reasonable and necessary as defined by Local Coverage Determination L35391.
Perform peripheral venous ultrasound to evaluate clinical signs or symptoms suggestive of acute or new-onset deep vein thrombosis (e.g., extremity swelling, tenderness, erythema).
Perform venous ultrasound to investigate DVT as the source of a confirmed pulmonary embolism.
Repeat or perform venous ultrasound for patients with known venous thrombosis who have a clinical change and where documented change in thrombus burden would alter management or therapy.
Perform venous ultrasound to evaluate postthrombotic (postphlebitic) syndrome in patients with symptoms consistent with PTS (e.g., chronic leg pain, heaviness, swelling, itching, or leg ulcers).
Perform venous ultrasound to evaluate suspected valvular incompetence in patients with symptomatic chronic venous insufficiency or symptomatic varicose veins when the result will confirm diagnosis prior to treatment.

L33693 — Peripheral Venous Ultrasound

J09

A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)

J12

A56848 — Billing and Coding: Multiple Imaging in Oncology

J12

L35007 — Vestibular and Audiologic Function Studies

J12

L35434

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