Does G0278 require prior authorization?

No, G0278 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0278?

Medicare facility rate: $11.69. Non-facility rate: $11.69. Work RVU: 0.24.

Verity

`G0278` — Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure)

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.24

Facility

$11.69

Non-Facility

$11.69

Documentation Required

The patient's medical record must fully document medical necessity for the cardiac catheterization and support the diagnosis and procedures billed.
Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and reason for the procedure and these codes must be linked to the CPT procedure codes on the claim.

When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim; for extra-cardiac angiographic services the treating physician's name and NPI must be submitted in items 17/17a of CMS-1500 or electronic equivalent.

For patients post-heart transplant without evidence of rejection, use primary diagnosis Z09 (follow-up after completed treatment) and secondary diagnosis Z94.1 (heart transplant status); add the underlying disorder code when coding I25.82 or I31.4.

All services/procedures performed on the same day for the same beneficiary by the same physician/provider must be billed on the same claim for Part B MAC submissions.

Each claim must be submitted with ICD-10-CM code(s) that accurately reflect the patient’s condition and indicate the reason(s) the service was performed.

Key Coverage Criteria

Medicare Part B covers the professional component of cardiac catheterization and coronary angiography when performed in hospital inpatient and outpatient facility settings.
Diagnostic cardiac catheterization performed in an office setting (where permitted) is covered under Medicare Part B for both professional and technical components.
Global and technical component procedures are covered under Part B when performed under personal physician supervision in an IDTF, free-standing facility, physician office, or physician-directed clinic (physician present in room for entire procedure).
Cardiac catheterization and coronary angiography are covered when the medical record documents medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests that support the procedure.
Diagnostic abdominal aortography and renal angiography are covered when they meet the reasonable and necessary clinical requirements specified in LCD L35092.
When femoral or iliac angiography is performed at the time of coronary angiography, bill using HCPCS code G0278.

12 Active Policies

L33557 — Cardiac Catheterization and Coronary Angiography

J06

A52850 — Billing and Coding: Cardiac Catheterization and Coronary Angiography

J06

A57056 — Billing and Coding: Aortography and Peripheral Angiography

J09

L36767 — Aortography and peripheral angiography

J09

L35092 — Diagnostic Abdominal Aortography and Renal Angiography

J12

A56682 — Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography

J12

CGS-L33959 — Cardiac Catheterization and Coronary Angiography

J18 MAC Part B

FIRST_COAST-L36767 — Aortography and peripheral angiography

J9 MAC Part B

NGS-L33557 — Cardiac Catheterization and Coronary Angiography

JK MAC Part B

NOVITAS-L35092 — Diagnostic Abdominal Aortography and Renal Angiography

JL MAC Part B

L33959 — Cardiac Catheterization and Coronary Angiography

A56500 — Billing and Coding: Cardiac Catheterization and Coronary Angiography

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