Does 92551 require prior authorization?

No, 92551 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 92551?

Medicare facility rate: $13.36. Non-facility rate: $13.36. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

$13.36

Non-Facility

$13.36

The CPB does not specify required documentation to support coverage because Aetna considers diagnostic tests and treatments for APD experimental and investigational. (No explicit documentation requirements are listed in the policy.)

None — Aetna considers any diagnostic tests or treatments for the management of auditory processing disorder (APD) (previously known as central auditory processing disorder (CAPD)) experimental and investigational because there is insufficient scientific evidence to support the validity of any diagnostic tests and the effectiveness of any treatment for APD.

AETNA-CPB-0668 — Auditory Processing Disorder (APD)

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