Does 94799 require prior authorization?

No, 94799 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 94799?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Evidence of exclusion/contraindications where applicable (e.g., documentation if patient is dependent on right-to-left shunt — FDA contraindication).
Documentation of gestational age at birth (to confirm term or near-term status, ≥34 weeks).
Clinical diagnosis documenting hypoxic respiratory failure or persistent pulmonary hypertension of the newborn (PPHN).
Echocardiographic evidence of PPHN when indicated (explicit echo report showing pulmonary hypertension/right-to-left shunting as applicable).

Inhaled nitric oxide (iNO) is proven and medically necessary for treating term or near-term infants (at least 34 weeks gestation at birth) with hypoxic respiratory failure or echocardiographic evidence of persistent pulmonary hypertension of the newborn (PPHN) when ALL of the following are present: absence of congenital diaphragmatic hernia (CDH) and failure of conventional treatments (e.g., mechanical ventilation).
Postoperative management of pulmonary hypertension associated with heart or lung surgery in infants: iNO is a clinically accepted option and will be covered as bridge therapy during the acute recovery phase.
Use of an unlisted CPT or HCPCS code when there is an absence of an available CPT or HCPCS procedure code that accurately describes the service.
Procedure that is entirely new, unproven, or potentially investigational (when an appropriate unlisted code is used and criteria are met).
An established procedure performed by a different method or approach (when an appropriate unlisted code is used and criteria are met).
An established procedure using a different device than described by standard available codes (when an appropriate unlisted code is used and criteria are met).

AMBETTER-CP.MP.87 — Therapeutic Utilization of Inhaled Nitric Oxide

UHC-POL-inhaled-nitric-oxide-therapy — Inhaled Nitric Oxide Therapy

UMR-POL-UMR-inhaled-nitric-oxide-therapy — Inhaled Nitric Oxide Therapy

CIGNA-0583 — Unlisted Procedure Codes - (0583)

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