Does 75580 require prior authorization?

Yes, 75580 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for 75580?

Medicare facility rate: $886.79. Non-facility rate: $886.79. Work RVU: 0.73.

HCPCS/CPT

Prior Auth Required

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

Work RVU

0.73

Facility

$886.79

Non-Facility

$886.79

The Fractional Flow Reserve analysis report must be included in the medical record and available for review/claim substantiation.
The claim must report the name and NPI of the referring/ordering physician who submitted imaging data for FFRct review.
The patient's medical record must document the clinical findings that led to the initial performance of the CCTA and evidence that the CCTA was fully reviewed prior to FFRct, demonstrated by submission of the Coronary Computed Tomographic Angiography Report.
The medical record must include a description of symptoms consistent with stable ischemic heart disease.

FFRct is indicated for evaluation of ischemic heart disease when imaging data from a previously performed Coronary CT Angiography (CCTA) are submitted for FFRct analysis.
FFRct is indicated when the patient has symptoms consistent with stable ischemic heart disease.
Non‑invasive FFR (FFRct) is covered when performed as post‑procedure analysis of a previously performed Coronary Computed Tomographic Angiography (CCTA) to evaluate suspected stable ischemic heart disease, provided the CCTA has been fully reviewed prior to FFRct.
FFRct is indicated when performed as post-procedure analysis of a previously performed Coronary CT Angiography (CCTA) and the CCTA has been fully reviewed prior to FFRct.
FFRct is indicated for patients undergoing evaluation for symptoms consistent with stable ischemic heart disease when CCTA has been obtained and reviewed.
Non-invasive FFR (FFRct) is performed as a post-procedure analysis of a previously performed coronary computed tomography angiography (CCTA) to evaluate ischemic heart disease.

A58473 — Billing and Coding: Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease

J05

L35490 — Category III Codes

J05

L38839 — Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease

J05

L33693 — Peripheral Venous Ultrasound

J09

L37371

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