Does 88240 require prior authorization?

No, 88240 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 88240?

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

"When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan."
"Before using this policy, please check the member specific benefit plan document and any applicable federal or state mandates."
No explicit clinical documentation requirements (e.g., required test results, clinical notes or prior authorization documentation) are specified in this policy for cord blood harvesting or storage; the policy directs that coverage of cord blood stem cell transplantation is addressed in the Optum Clinical Guideline titled Hematopoietic Stem Cell Transplantation.
If directed/family banking is being considered, supporting documentation (not specified in policy) would be expected to include evidence of a family member's diagnosable condition that is potentially treatable with cord blood transplantation (policy cites society guidance recommending directed banking in such cases).

No covered prophylactic indication specified. "Due to insufficient evidence of efficacy, prophylactic collection and storage of umbilical cord blood is unproven and not medically necessary for an individual who is currently healthy but desiring to provide the opportunity for a future unspecified autologous or allogeneic stem cell transplantation."
No other explicit covered indications are stated in this policy. (Policy directs to the Optum Clinical Guideline titled Hematopoietic Stem Cell Transplantation for additional information and coverage of umbilical cord blood stem cell transplantation.)

UMR-POL-UMR-umbilical-cord-blood-harvesting-and-storage-future-use — Umbilical Cord Blood Harvesting and Storage for Future Use

SUREST-POL-SUREST-umbilical-cord-blood-harvesting-and-storage-future-use — Umbilical Cord Blood Harvesting and Storage for Future Use

BCBSIL-SUR703.058 — Collection and Storage of Umbilical Cord Blood Stem Cells

BCBSMT-SUR703.058 — Collection and Storage of Umbilical Cord Blood Stem Cells

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