Does 93980 require prior authorization?

No, 93980 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 93980?

Medicare facility rate: $3.70. Non-facility rate: $3.70. Work RVU: 1.22.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.22

Facility

$3.70

Non-Facility

$3.70

The ordering physician/nonphysician practitioner must state the clinical indication and medical necessity for the study in the order.
The performing provider must maintain a permanent record of the performed study and interpretation, and must retain a copy of the ordering provider’s order and the test results.
The report must describe the studies performed, note any contrast media or radiopharmaceuticals used, record any significant patient reactions or complications, and compare with prior relevant imaging.
Variations from normal size must be documented with measurements and the report should address specific clinical questions or explain why questions cannot be answered.

Non‑invasive abdominal/visceral vascular studies are covered when the test results will be used to directly inform or change the patient's clinical management.
A preoperative non‑invasive abdominal/visceral vascular study is covered as reasonable and necessary for patients undergoing bypass surgery (one preoperative scan considered reasonable).
Medically necessary follow‑up non‑invasive abdominal/visceral vascular studies after angioplasty are covered as indicated by the vascular distribution treated.
Non‑invasive abdominal/visceral vascular studies performed in the inpatient hospital (place of service 21) or emergency room (place of service 23) are permitted and are not subject to the routine once‑per‑year outpatient limitation.
An IDTF must be credentialed and approved by Palmetto GBA provider enrollment to bill Medicare for a specific diagnostic procedure or material.
Additional services and supplies (e.g., radiopharmaceuticals, special contrast agents, medications) are payable to an IDTF when the diagnostic test itself is payable and the supplies are commonly separately reimbursed to a physician in an office setting.

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

J05

L35755 — Non-Invasive Abdominal / Visceral Vascular Studies

J05

L33693 — Peripheral Venous Ultrasound

J09

L35434 — Oximetry Services

J12

L35451 — Peripheral Venous Ultrasound

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