Does 77013 require prior authorization?

No, 77013 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 77013?

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

No discrete 'Documentation Requirements' section is provided in this excerpt; however the policy implies that clinical documentation must support the specific selection criteria attached to each covered indication (examples below).
For renal mass cryoablation: documentation of tumor size (≤4 cm) and documentation that patient meets at least one criterion: high-risk surgical candidate; renal insufficiency with documented GFR ≤ 60 ml/min/1.73 m2; or solitary kidney
For adrenal gland metastases: documentation of adrenal lesion size (≤4 cm) (and typically documentation of metastatic disease and rationale for percutaneous ablation vs. surgery)
For pulmonary metastatic lesions: documentation that member is not a surgical candidate and that there are ≤ 6 lesions each < 4 cm in diameter

HUMANA-RADIOFREQUENCY-TUMOR-ABLATION-MA — Radiofrequency Tumor Ablation - Medicare Advantage

AETNA-CPB-0100 — Cryoablation

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