Does 98985 require prior authorization?

No, 98985 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 98985?

Medicare facility rate: $51.44. Non-facility rate: $51.44. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

$51.44

Non-Facility

$51.44

RTM is not primarily for the convenience of the individual, physician, caregiver, or other health care provider;and
Remotetherapeuticmonitoring (RTM) in a non-healthcare setting is consideredmedically necessarywhen clinical records document the rationale for monitoring includingALLof the following:
RTM is clinically appropriate, in terms of type, quantity, frequency, extent, site and duration and is considered effective for the individualâs illness, injury or disease and in accordance with generally accepted standards of medical practice*;and
RTM data is being regularly assessed to detect acute changes in clinical status and prompt intervention;and
The individual is at risk of clinically significant changes in medical status which warrant enhanced monitoring based on current status and instability of the underlying clinical condition;and
The individual is unable to access regularly scheduled outpatient clinical care or therapeutic monitoring is required between visits due to potential changes in medical status;and

ANTHEM-CG-MED-91 — CG-MED-91 Remote Therapeutic and Physiologic Monitoring Services

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