Does 94016 require prior authorization?

No, 94016 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 94016?

Medicare facility rate: $24.72. Non-facility rate: $24.72. Work RVU: 0.51.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.51

Facility

$24.72

Non-Facility

$24.72

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
The patient's medical record must include the ordering provider's assessment related to the patient's complaint for that visit.
The patient's medical record must include relevant medical history and results of pertinent tests/procedures; for diagnostic tests report the test result if known, otherwise report the symptoms prompting the test.
Signed and dated office visit records or operative reports are required for all services ordered or rendered to Medicare beneficiaries.

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.
A supervising physician for an IDTF must be licensed in the state(s) where tests are performed, enrolled in Medicare, not excluded, meet proficiency standards for tests supervised, and provide general supervision for no more than three IDTF sites.
An interpreting physician must be licensed in the state(s) where tests are performed, enrolled in Medicare, not excluded, and qualified to interpret the types of tests (codes) listed on the IDTF enrollment application.
An IDTF technician must meet applicable state licensure and/or certification standards at the time of enrollment and/or at the time tests are performed and be qualified to perform the types of tests (codes) listed in the enrollment application.
For each CPT/HCPCS code listed in the policy, the supervising physician and technician must meet the specialty and certification qualifications specified in the policy’s code-to-qualification mapping to be reimbursable by Medicare.

L33693 — Peripheral Venous Ultrasound

J09

A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)

J12

L35007 — Vestibular and Audiologic Function Studies

J12

L35434 — Oximetry Services

J12

L35451 — Peripheral Venous Ultrasound

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