Does 93581 require prior authorization?

No, 93581 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 93581?

Medicare facility rate: $1145.65. Non-facility rate: $1145.65. Work RVU: 23.78.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

23.78

Facility

$1145.65

Non-Facility

$1145.65

For PDA: clinical documentation supporting device selection (policy references use of Amplatzer ductal occluder in moderate-to-large PDAs and prior trials showing use in pediatric population).
General documentation implied by policy: pre-procedure and follow-up echocardiography (TEE/TTE) and clinical follow-up notes (policy cites necessity of pre-procedure and post-procedure echo and follow-up schedules in clinical studies).
No explicit documentation requirements (e.g., precise CMS/Medicare medical necessity statement or required ICD-10 documentation) are stated in the provided text.
Echocardiographic morphology documentation for ASDs: 'echocardiographic morphology of the ASD with reference to size, position in the interatrial septum, proximity to surrounding structures, and adequacy of septal rim.'

93582 Percutaneous transcatheter closure of patent ductus arteriosus
Aspiration thrombectomy with the AngioVac system for percutaneous removal of thrombus in the venous system.
Right-sided transcatheter vacuum-assisted mass extraction (TVME) including: right-sided heart chamber thrombi, right-sided infective endocarditis (RSIE) vegetations, venous thrombus, lead-related infection/thrombus aspiration, and right-sided cardiac mass evacuation.
AngioVac-assisted vegetation debulking (AVD) for right-sided infective endocarditis (RSIE) — described in systematic reviews and case series with reported procedural and clinical success.
Percutaneous vacuum-assisted debulking of large vegetations as an adjunct to lead extraction.
Transcatheter vacuum-assisted left-sided mass extraction (left-sided TVME) — reported in small case series and single-center reports (noted as limited/experimental/off-label use in the text).

AETNA-CPB-0292 — Catheter-Directed Cardiac Procedures

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