Does 99491 require prior authorization?

No, 99491 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 99491?

Medicare facility rate: $65.47. Non-facility rate: $89.18. Work RVU: 1.50.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.50

Facility

$65.47

Non-Facility

$89.18

No specific documentation requirements are specified in this policy; consult the member's benefit plan/contract for required documentation and prior authorization rules.
Document review of the member's benefit contract or Summary Plan Description (SPD) to establish applicable coverage, exclusions, and benefit limitations.
Include applicable written Medical Policy coverage positions when making coverage determinations.

Coverage for custodial care is not defined by this policy; whether custodial services and supplies are covered is determined by the member's benefit plan/contract.
Services provided primarily for personal comfort or convenience that provide general maintenance, preventive, and/or protective care without clinical likelihood of improvement
Assistance with walking and transferring (e.g., getting in and out of bed)
Assistance with bathing, dressing, feeding, and toileting
Preparation of special diets
Supervision of medication that can usually be self‑administered

BCBSIL-ADM1001.014 — Custodial Care

BCBSMT-ADM1001.014 — Custodial Care

BCBSNM-ADM1001.014 — Custodial Care

BCBSOK-ADM1001.014 — Custodial Care

ADM1001.014 — Custodial Care

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