Does 93655 require prior authorization?

Yes, 93655 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for 93655?

Medicare facility rate: $260.86. Non-facility rate: $260.86. Work RVU: 5.36.

Verity

`93655`

HCPCS/CPT

Prior Authorization

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Medicare Pricing

Work RVU

5.36

Facility

$260.86

Non-Facility

$260.86

Documentation Required

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage.
Refer to the protocol titled Medical Records Documentation Used for Reviews.
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.

Key Coverage Criteria

Catheter ablation for atrial fibrillation is proven and medically necessary in certain circumstances.
For medical necessity clinical coverage criteria, refer to the InterQual® CP: Procedures, Electrophysiology (EP) Testing +/- Radiofrequency Ablation (RFA) or Cryothermal Ablation, Cardiac.
This Medical Policy applies to UnitedHealthcare Commercial benefit plans.
This Medical Policy applies to Individual Exchange benefit plans.
Note: This policy does not apply to members ages < 18 years or to arrhythmias other than atrial fibrillation.
VT: members with symptomatic sustained monomorphic VT when the tachycardia is drug-resistant or the member is drug-intolerant or does not desire long-term drug therapy

8 Active Policies

AETNA-CPB-0165 — Cardiac Catheter Ablation and Radioablation

CARELON-transcatheter-ablation-for-supraventricular-and-ventricular-arrhythmias-2024-07-01 — Transcatheter Ablation for Supraventricular and Ventricular Arrhythmias

CARELON-transcatheter-ablation-for-management-of-atrial-fibrillation-2024-07-01-r0125 — Transcatheter Ablation for Management of Atrial Fibrillation

UMR-POL-UMR-catheter-ablation-atrial-fibrillation — Catheter Ablation for Atrial Fibrillation

Have a follow-up question?

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

93655