Does 95971 require prior authorization?

No, 95971 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 95971?

Medicare facility rate: $34.40. Non-facility rate: $50.44. Work RVU: 0.78.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.78

Facility

$34.40

Non-Facility

$50.44

Appropriate medical documentation supporting need for repeat trial or exceptions (e.g., technical limitations, different modality/new technology) must be submitted for appeals.
Providers must verify applicable CCI edits and correct coding guidelines prior to billing Medicare; this article does not replace CCI guidance.
Claims must be supported by medical record documentation demonstrating that the service meets the LCD L39543 indications and limitations and general CMS medical necessity requirements.
Medical record must contain documented history and careful screening, including multidisciplinary evaluation and both psychological and physical assessments, available on request.

Placement of up to 2 spinal cord stimulator leads or a maximum of 16 contacts is reimbursable.
Up to 2 SCS trials per anatomic spinal region per patient per lifetime are reimbursable, with exceptions for technical limitations or use of different stimulation modalities/new technology.
CPT 63650 (temporary/percutaneous SCS trial) is reimbursable in office, ASC, outpatient hospital, or hospital settings.
Permanent spinal cord stimulator implantation (CPT 63655) is reimbursable once per patient per lifetime and must be performed in an ASC, outpatient hospital, or hospital.
Percutaneous placement of permanent neurostimulator arrays (using CPT 63650) may be covered more often when performed in ASC, outpatient hospital, or hospital settings.
Services for sacral nerve stimulation are covered only when they meet all indications specified in Local Coverage Determination L39543 for treatment of urinary and/or fecal incontinence.

AMBETTER-CP.MP.137 — Fecal Incontinence Treatments

AMBETTER-CP.MP.117 — Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation

AETNA-CPB-0614 — Huntington's Disease

A56876 — Billing and Coding: Spinal Cord Stimulators for Chronic Pain

A59332 — Billing and Coding: Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence

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