Does 93990 require prior authorization?

No, 93990 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 93990?

Medicare facility rate: $3.28. Non-facility rate: $3.28. Work RVU: 0.49.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.49

Facility

$3.28

Non-Facility

$3.28

When an ABN is issued and liability is being transferred, a signed ABN Form CMS-R-131 must be retained in the beneficiary record; Part A MAC claims require occurrence code 32 and the ABN date.
The medical record must include the ordering provider's assessment related to the patient's complaint for the visit and relevant medical history.
Results of pertinent tests or procedures must be documented; for diagnostic tests, report the test result if known or otherwise the symptoms prompting the test.
Office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.

Claims for dialysis access maintenance billed to Medicare Part A or Part B should be submitted when coding conforms to the applicable Local Coverage Determination L34062 and applicable NCCI and OPPS coding/packaging edits.
For services that require a referring or ordering physician, claims must include the referring/ordering physician's name and NPI to be eligible for payment.
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).

A57594 — Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

J05

L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

J05

L33627 — Non-Invasive Vascular Studies

J06

A56758 — Billing and Coding: Non-Invasive Vascular Studies

J06

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