Does 76998 require prior authorization?

No, 76998 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 76998?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Medical record documentation must show the diagnosis of Grade II or III hemorrhoids and that the patient failed prior rubber band ligation or conservative measures (behavior modification, high-fiber diet, topical hydrocortisone cream/suppositories).
Claims for the procedure must be submitted using CPT code 46948 on the claim form.
Baseline documentation of clinical status including CEAP classification (e.g., CEAP class C2 to C6 where applicable), Venous Clinical Severity Score (VCSS), and disease‑specific and generic quality‑of‑life measures (e.g., AVVQ, VEINES‑QOL/Sym, SF‑36, EQ‑5D) as used in trials.
Record of exclusion criteria where applicable (e.g., documentation that patient does not have current DVT, serious arterial disease, active venous leg ulcer where excluded, or is not on contraindicated anticoagulation if study/exclusion applied).

Doppler-guided hemorrhoid artery ligation, with or without retroanal repair, is a covered service.
Coverage is limited to patients with Grade II hemorrhoids.
Coverage is limited to patients with Grade III hemorrhoids.
Hemorrhoid artery ligation is covered only after failure of rubber band ligation or failure of conservative treatment (behavior modification, high-fiber diet, and topical hydrocortisone cream or suppositories).
Symptomatic varicose veins of the lower extremities (general indication for discussion of all listed therapies).
Great saphenous vein (GSV) insufficiency / truncal GSV reflux — eligible for treatment with mechanochemical ablation (MOCA/Clarivein), cyanoacrylate adhesive closure (CAC/VenaSeal and similar), endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), or conventional surgery (ligation and stripping) depending on clinical judgement.

AETNA-CPB-0179 — Viscosupplementation

A53006 — Billing and Coding: Hemorrhoid Artery Ligation

AETNA-CPB-0050 — Varicose Veins

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