Does A4594 require prior authorization?

No, A4594 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for A4594?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Verity

`A4594`, Neuromodulation stimulator system, adjunct to rehabilitation therapy regime,

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Claims may require medical records documentation to assess whether the member meets the clinical criteria for coverage; however, documentation does not guarantee coverage.
Documentation/tests demonstrating adequate/retained function of the phrenic nerves and diaphragm.
Documentation of the diagnosis of ventilatory insufficiency or ventilatory failure.
Clinical documentation demonstrating that the device is no longer necessary for the patient's medical condition.

Key Coverage Criteria

Partial or complete paralysis may occur when the brain and spinal cord are damaged by injury, stroke or acute disease.
Neuromuscular electrical stimulation (NMES) used as part of physical therapy to retrain voluntary muscle control and preserve range of motion.
NMES used in rehabilitation to accelerate and improve functional recovery after brain or spinal cord damage.
Neuromuscular electrical stimulation (NMES) as a complementary approach to rehabilitation to elicit muscle contraction.
To control edema in an immobilized extremity following a documented injury or surgical intervention.
To increase local blood circulation in an immobilized extremity following a documented injury or surgical intervention.

4 Active Policies

HUMANA-FUNCTIONAL-ELECTRICAL-STIMULATORS-NON-PAIN-MA, Functional Electrical Stimulators (Non-Pain)

UHC-POL-electrical-stimulation-treatment-pain-muscle-rehabilitation, Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation

UMR-POL-UMR-electrical-stimulation-treatment-pain-muscle-rehabilitation, Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation

SUREST-POL-SUREST-electrical-stimulation-treatment-pain-muscle-rehabilitation, Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation

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A4594, Neuromodulation stimulator system, adjunct to rehabilitation therapy regime,