Does A9526 require prior authorization?

Yes, A9526 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for A9526?

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

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Claims for stress tests performed as preoperative evaluation of asymptomatic, moderate-risk patients must include medical record documentation of at least one of: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.
When PET Rb-82 is performed after an equivocal, technically uninterpretable, or discordant SPECT, the clinical reason and medical necessity for PET must be clearly documented in the patient's medical record.
Baseline cardiac blood pool imaging prior to cardiotoxic chemotherapy requires documentation that no echocardiogram is planned or that prior echocardiogram was uninterpretable.
Cardiac function monitoring during or after cardiotoxic chemotherapy requires documentation of the chemotherapy agents administered and the clinical indication for monitoring.

Preoperative cardiac stress testing with radionuclide imaging for asymptomatic patients deemed at moderate risk is covered only if the medical record documents at least one of the following: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.
Diagnose CAD in individuals with at least intermediate-risk when PET perfusion imaging is used due to indeterminate or suboptimal noninvasive tests (e.g., indeterminate SPECT or suboptimal body habitus/technical factors).
Medically necessary for diagnosing CAD in individuals with at least intermediate pretest risk when (a) there are indeterminate noninvasive tests or (b) SPECT is expected to be suboptimal due to body habitus or technical problems.
Medically necessary for assessing myocardial perfusion to diagnose CAD in individuals with intermediate CAD risk when there are indeterminate noninvasive tests or anticipated suboptimal SPECT quality (e.g., BMI >35 kg/m2, large breasts/implants, prior indeterminate SPECT, prior MI).
PET scanning is medically necessary to assess myocardial perfusion to diagnose CAD in individuals with intermediate risk when there are indeterminate noninvasive tests or anticipated suboptimal SPECT quality.
Myocardial perfusion imaging (MPI/SPECT) is covered for diagnosis and management of coronary artery disease (CAD), including evaluation of atypical chest pain, abnormal or suspected false-positive stress ECG, and other symptoms suspicious for CAD.

PALMETTO-JJ-L33457, Cardiac Radionuclide Imaging

PALMETTO-JM-L33457, Cardiac Radionuclide Imaging

BCBSMT-RAD605.001, Cardiac Applications of Positron Emission Tomography Scanning

BCBSNM-RAD605.001, Cardiac Applications of Positron Emission Tomography Scanning

BCBSOK-RAD605.001

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