Does 72125 require prior authorization?

No, 72125 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 72125?

Medicare facility rate: $3.54. Non-facility rate: $3.54. Work RVU: 0.98.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.98

Facility

$3.54

Non-Facility

$3.54

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.
Title XVIII of the Social Security Act, Section 1833(e) prohibits Medicare payment for any claim, which lacks the necessary information to process the claim.
Documentation must support that the scan is reasonable and necessary.
Accurate coding information must be provided with claims to differentiate CT and/or MRI scans from other radiology services and to make coverage determinations.

Multiple imaging studies in oncology are covered only when reasonable and necessary as defined by Local Coverage Determination L35391.
G71.21 | Nemaline myopathy
G83.0 | Diplegia of upper limbs
H44.19 | Other endophthalmitis
H44.532 | Leucocoria, left eye
H44.533 | Leucocoria, bilateral

L33693 — Peripheral Venous Ultrasound

J09

A56848 — Billing and Coding: Multiple Imaging in Oncology

J12

L35391 — Multiple Imaging in Oncology

J12

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

J12

L35007 — Vestibular and Audiologic Function Studies

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