Does 75572 require prior authorization?

No, 75572 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 75572?

Medicare facility rate: $11.22. Non-facility rate: $11.22. Work RVU: 1.71.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.71

Facility

$11.22

Non-Facility

$11.22

For services requiring a referring/ordering physician, the referring/ordering provider's name and NPI must be reported on the claim.
The patient's medical record must document assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports for all services ordered or rendered.
Claims must be submitted with ICD-10-CM codes that reflect the patient's condition and reason for the service; claims without ICD-10-CM codes will be returned.
The study requires a formal written interpretive report including clear identifying demographics, the interpreting provider's name, reason for the test, an interpretive report, copies of images, and maintenance of computerized image reconstruction data.

CCT/CCTA is covered when the patient's medical record documents medical necessity consistent with Local Coverage Determination L33947 and the claim is submitted with an appropriate ICD-10-CM diagnosis code reflecting the reason for testing.
Cardiac CT (CCT) or Coronary CT Angiography (CCTA) is covered when the patient's medical record documents medical necessity consistent with the indications and limitations set forth in the attached Local Coverage Determination (LCD).
Coverage indications for Coronary Computed Tomography Angiography (CCTA) are defined in the associated Local Coverage Determination LCD L35121; consult LCD L35121 for specific clinical criteria and medical necessity requirements.
CCTA is covered to reliably rule out significant CAD in patients with low-to-intermediate pretest probability of CAD.
CCTA is covered to facilitate management when a patient has an equivocal stress test (including equivocal stress imaging) and additional anatomic coronary information would change management.
CCTA is covered to evaluate patients presenting with chest pain syndrome when the clinician suspects coronary artery disease (CAD) and the test will be used in lieu of an imaging stress test.

A57552 — Billing and Coding: Coronary Computed Tomography Angiography (CCTA)

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L35121 — Coronary Computed Tomography Angiography (CCTA)

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L39913 — Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

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L35490 — Category III Codes

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