Does 92540 require prior authorization?

No, 92540 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 92540?

Medicare facility rate: $103.54. Non-facility rate: $103.54. Work RVU: 1.46.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.46

Facility

$103.54

Non-Facility

$103.54

All documentation must be maintained in the patient's medical record, be legible, include appropriate patient identification (e.g., full name) and dates of service, and be made available to the contractor upon request.
The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Retain and provide copies of hard-copy output with analysis of all data (including bidirectional vascular flow or imaging when provided) in the patient record.

CPT codes 92553, 92557, and 92568 are allowable when the beneficiary has current long-term use of ototoxic antibiotics.
The professional component (PC) of CPT codes 92537, 92538, 92541, 92542, 92544, 92545, 92546, 92587, 92588, 92651, 92652, and 92653 may be reported when the PC is performed in inpatient, outpatient, rehabilitation facilities, nursing facilities (when Part A benefits are exhausted), hearing and speech centers, independent clinics, or independent diagnostic testing facilities (IDTF).
Technical-only CPT codes 92547, 92552, 92553, 92555, 92556, 92562, 92563, 92565, 92571, 92572, 92575, 92576, 92577, 92582, 92583, and 92584 may be reported when performed in office settings, clinics, hearing and speech centers, and nursing facilities.
Payment for technical components of TC/PC services (when the PC is performed by an appropriate professional) and for technical-only services is allowed to hospitals.
Perform peripheral venous ultrasound to evaluate clinical signs or symptoms suggestive of acute or new-onset deep vein thrombosis (e.g., extremity swelling, tenderness, erythema).
Perform venous ultrasound to investigate DVT as the source of a confirmed pulmonary embolism.

L33693 — Peripheral Venous Ultrasound

J09

L35434 — Oximetry Services

J12

L35451 — Peripheral Venous Ultrasound

J12

L35007 — Vestibular and Audiologic Function Studies

J12

A57434 — Billing and Coding: Vestibular and Audiologic Function Studies

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