Does 85651 require prior authorization?

No, 85651 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 85651?

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

The submitted CPT/HCPCS code must accurately describe the ESR service performed.
Maintain the full medical record and make it available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., full name and dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

Erythrocyte sedimentation rate (ESR) testing is covered only when reasonable and necessary as defined by Local Coverage Determination L34021.
ESR performed for rheumatoid arthritis patients to assess the need for medication adjustments should be billed with a diagnosis code that reflects the specific antirheumatic medication the patient is receiving.
Use ICD-10 codes T39.4X5A–T39.4X5S for ESR billing when the patient with rheumatoid arthritis is receiving antirheumatics such as gold salts for medication evaluation.
Use ICD-10 codes T45.1X5A–T45.1X5S for ESR billing when the patient with rheumatoid arthritis is receiving antineoplastic or immunosuppressive drugs such as methotrexate for medication evaluation.
Use ICD-10 codes T45.8X5A–T45.8X5S for ESR billing when the patient with rheumatoid arthritis is receiving other primarily systemic and hematological agents such as heavy metal antagonists for medication evaluation.
Use ICD-10 codes T50.6X5A–T50.6X5S for ESR billing when the patient with rheumatoid arthritis is receiving antidotes and chelating agents such as penicillamine for medication evaluation.

A57657 — Billing and Coding: Sedimentation Rate, Erythrocyte

J09

L34021 — Sedimentation Rate, Erythrocyte

J09

FIRST_COAST-L34021 — Sedimentation Rate, Erythrocyte

J9 MAC Part B

AETNA-CPB-0369 — Chronic Fatigue Syndrome

REGENCE-LAB80 — Screening Laboratory Testing

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