Does 93978 require prior authorization?

Yes, 93978 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for 93978?

Medicare facility rate: $7.48. Non-facility rate: $7.48. Work RVU: 0.78.

HCPCS/CPT

Prior Auth Required

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

Work RVU

0.78

Facility

$7.48

Non-Facility

$7.48

The ordering/referring practitioner's assessment related to the patient's complaint and the specific reason for the test must be documented in the medical record.
The medical record must contain a referral/order on file for each non‑invasive vascular study performed.
Results of pertinent tests and procedures performed that relate to the indication must be included in the medical record and reported on the claim if known; otherwise report the symptoms that prompted the test.
Signed and dated office visit notes and operative reports must be present in the record for the services ordered or rendered to Medicare beneficiaries.

Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 50–79% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 80–99% if surgical correction has not been performed.
After carotid endarterectomy, repeat ipsilateral (unilateral) duplex examinations are allowable at approximately six weeks, six months, and one year post‑procedure during the first year.

L35755 — Non-Invasive Abdominal / Visceral Vascular Studies

J05

A57591 — Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies

J05

L33627 — Non-Invasive Vascular Studies

J06

A56758 — Billing and Coding: Non-Invasive Vascular Studies

J06

L33693

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