Does 99116 require prior authorization?

No, 99116 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 99116?

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

General Anesthesia or Regional AnesthesiaAdministration of general or regional anesthesia is consideredmedically necessarywhen both of the following criteria are met:
The services are provided by an individual other than the attending physician performing the procedure;and
Alternative types of anesthesia, sedation, or analgesia are not appropriate.
If general or regional anesthesia is requested for a procedure typically not requiring either of these levels of anesthesia service, a medical necessity review will be performed. This review will assess not only the procedure involved, but also other individual-specific issues, such as age, mental status, ability to cooperate, co-morbid conditions, and general medical status.
Monitored Anesthesia Care (MAC)Monitored anesthesia care (MAC) is consideredmedically necessarywhenallof the following criteria are met:
MAC is requested by the attending physician;and

ANTHEM-CG-MED-21 — CG-MED-21 Anesthesia Services and Moderate (âConsciousâ) Sedation

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