Does 93280 require prior authorization?

No, 93280 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 93280?

Medicare facility rate: $78.49. Non-facility rate: $78.49. Work RVU: 0.75.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.75

Facility

$78.49

Non-Facility

$78.49

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information, including complete name and dates of service.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

When billing Medicare Part B for analysis of a Wearable Defibrillator System, report CPT code 93292.
Report CPT codes 93260, 93261, and 93279-93292 when performing the corresponding cardiac rhythm device evaluation procedures (reported per procedure).
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.
Repeat or perform venous ultrasound for patients with known venous thrombosis who have a clinical change and where documented change in thrombus burden would alter management or therapy.
Perform venous ultrasound to evaluate postthrombotic (postphlebitic) syndrome in patients with symptoms consistent with PTS (e.g., chronic leg pain, heaviness, swelling, itching, or leg ulcers).

L33693 — Peripheral Venous Ultrasound

J09

L34833 — Cardiac Rhythm Device Evaluation

J12

A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)

J12

L35007 — Vestibular and Audiologic Function Studies

J12

L35434 — Oximetry Services

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