Does 72142 require prior authorization?

Yes, 72142 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for 72142?

Medicare facility rate: $11.24. Non-facility rate: $11.24. Work RVU: 1.74.

HCPCS/CPT

Prior Auth Required

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

Work RVU

1.74

Facility

$11.24

Non-Facility

$11.24

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.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.

Multiple imaging studies in oncology are covered only when reasonable and necessary as defined by Local Coverage Determination L35391.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
G71.21 | Nemaline myopathy
G83.0 | Diplegia of upper limbs
H44.19 | Other endophthalmitis

L33693 — Peripheral Venous Ultrasound

J09

L37371 — Electroretinography (ERG)

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.