Does 75984 require prior authorization?

No, 75984 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 75984?

Medicare facility rate: $93.86. Non-facility rate: $93.86. Work RVU: 0.81.

Verity

`75984`

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.81

Facility

$93.86

Non-Facility

$93.86

Documentation Required

Documentation of candidacy for surgery / statement that the patient is not a surgical candidate (policy history added 'candidacy for surgery').
Imaging to establish diagnosis, disease distribution and liver-dominant disease (contrast-enhanced liver protocol CT or MRI to determine lesion burden and identify imaging factors such as ascites).
Documentation of tumor site and type of primary malignancy and metastatic lesion(s) (policy history: 'site and type of primary malignancy and metastatic lesion(s)').
Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage.

Key Coverage Criteria

This policy applies to individuals 19 years of age and older. Transarterial Radioembolization/selective internal radiation therapy is covered without further review for individuals younger than 19 years of age.
Transarterial Radioembolization (TARE)/selective internal radiation therapy (SIRT) using yttrium-90 microspheres is proven and medically necessary for the following indications in individuals with an Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1, or 2:
Liver dominant primary hepatocellular carcinoma (HCC) in individuals who are not surgical candidates
Primary hepatocellular carcinoma as a bridge to liver transplantation
Liver metastases from neuroendocrine tumors in individuals who are not surgical candidates when systemic therapy has failed to control symptoms
Liver metastases from colorectal carcinoma in individuals with chemotherapy-resistant or Refractory disease and with predominant hepatic metastases

3 Active Policies

UHC-POL-transarterial-radioembolization — Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver

UMR-POL-UMR-transarterial-radioembolization — Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver

SUREST-POL-SUREST-transarterial-radioembolization — Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver

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75984