Does 86891 require prior authorization?

No, 86891 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 86891?

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

Verity

`86891`

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation that the blood to be salvaged is not contaminated (no evidence of infection or fecal contamination) and does not contain malignant cells when applicable (i.e., documentation addressing contraindications).
When CPT codes 86890/86891 are billed, supporting clinical records should indicate that selection criteria for coverage were met (e.g., indication, anticipated/actual transfusion need, and operative circumstances).
No explicit, detailed documentation requirements are specified in the policy text.
Policy indicates CPT codes and ICD-10 codes are 'covered if selection criteria are met' — documentation demonstrating that the applicable 'selection criteria' are met would be required for coverage (selection criteria are not detailed in the policy).

Key Coverage Criteria

O00.00 - O00.91 — Ectopic pregnancy
O08.1 — Delayed or excessive hemorrhage following ectopic and molar pregnancy
O44.10 - O44.13 — Placenta previa with hemorrhage
O45.001 - O45.099 — Premature separation of placenta with coagulation defect
O46.001 - O46.099 — Antepartum hemorrhage with coagulation defect
O67.0 — Intrapartum hemorrhage with coagulation defect

1 Active Policy

AETNA-CPB-0639 — Autotransfusers

Have a follow-up question?

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

Implied documentation to support medical necessity (not explicitly listed) would include documentation of the clinical scenario/procedure with expected or actual major blood loss (e.g., operative notes, estimated blood loss), diagnosis corresponding to one of the listed ICD-10 codes, and justification that expected blood requirements meet the policy's medical necessity threshold (e.g., expected need >= 2 units).

86891