Does 97155 require prior authorization?

No, 97155 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 97155?

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

Claims and coding for cervical disc replacement must follow the Local Coverage Determination (LCD) L38033 and the billing/coding guidelines in this article.
Documentation must show the CDR device used is FDA-approved for the treated indication (including 2-level approval if applicable).
Imaging documentation (CT, myelography, or MRI) demonstrating corresponding nerve root or spinal cord compression must be included in the medical record.
Medical records must document at least 6 weeks of failed conservative non-operative treatment when applicable, including physician-directed pain management and physical therapy.

The prosthetic cervical disc device is FDA-approved for the indicated use.
The beneficiary is skeletally mature.
The beneficiary has intractable cervical radicular pain or cervical myelopathy that has failed at least 6 weeks of conservative non-operative treatment including physician-directed pain management (e.g., pharmacotherapy for neuropathic pain) and physical therapy.
Alternatively, the beneficiary has severe or rapidly progressive symptoms of nerve root or spinal cord compression requiring hospitalization or immediate surgical intervention.
There must be clinical evidence of corresponding nerve root or spinal cord compression documented by CT, myelography, or MRI.
Cervical degenerative disc disease (CDDD) at a single level between C3 and C7.

PALMETTO-L38033 — Cervical Disc Replacement

JJ Part B

AMBETTER-CP.BH.105 — Applied Behavioral Analysis Documentation Requirements

A57021 — Billing and Coding: Cervical Disc Replacement

AMBETTER-CP.BH.104 — Applied Behavior Analysis

CIGNA-EN0499 — Intensive Behavioral Interventions - (EN0499)

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