Does G0281 require prior authorization?

No, G0281 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0281?

Medicare facility rate: $11.69. Non-facility rate: $11.69. Work RVU: 0.18.

Verity

`G0281` — Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.18

Facility

$11.69

Non-Facility

$11.69

Documentation Required

For wound-related modalities (G0281, G0329) document wound etiology and duration and prior treatments by physician, non-physician practitioner, nurse, and/or therapist (additional required wound documentation text truncated in source).
For 97032, document the type of electrical stimulation (specify 'manual' and 'attended'), area(s) treated, and when used for muscle weakness include objective strength ratings and functional deficits; when used for pain include pain rating, pain location, and effect of pain on function.

Key Coverage Criteria

CPT 97032 (attended/manual electrical stimulation) is covered when delivered with direct 1-on-1 contact by qualified personnel (examples: direct motor point stimulation; FES/NMES when performed with therapeutic exercise, neuromuscular reeducation, or functional activities).
CPT 97032 may be billed for the application, instruction, and adjustment of a TENS unit or other probe-based stimulation (including determining trigger points) when provided as an attended/manual modality.
Non-implantable pelvic floor electrical stimulation (97032 for probes; G0283 for electrode-based delivery) is covered for treatment of stress and/or urge urinary incontinence in cognitively intact, motivated patients who have failed a documented 4-week trial of pelvic muscle exercise (PME) training.
HCPCS G0283 (unattended/supervised electrical stimulation) is covered for non-wound-care indications as part of a therapy plan of care when delivered without constant direct contact after skilled application (examples: TENS, IFC, cyclical muscle stimulation).
HCPCS G0329 (electromagnetic therapy) is covered for chronic stage III/IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that show no measurable signs of healing after 30 days of conventional care as part of a therapy plan of care.
HCPCS G0281 (unattended electrical stimulation for wounds) is covered for chronic stage III/IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that are not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care.

20 Active Policies

L37228 — Wound Care

J05

A55909 — Billing and Coding: Wound Care

J05

L33631 — Outpatient Physical and Occupational Therapy Services

J06

A56566 — Billing and Coding: Outpatient Physical and Occupational Therapy Services

J06

AETNA-CPB-0680 — Electrical Stimulation for Chronic Ulcers

UHC-POL-habilitative-services-outpatient-rehabilitation-therapy — Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech)

A53064 — Billing and Coding: Outpatient Occupational Therapy

A53065 — Billing and Coding: Outpatient Physical Therapy

A57067 — Billing and Coding: Outpatient Physical and Occupational Therapy Services

A57311 — Billing and Coding: Physical Therapy - Home Health

L34427 — Outpatient Occupational Therapy

L34428 — Outpatient Physical Therapy

L34049 — Outpatient Physical and Occupational Therapy Services

L33942 — Physical Therapy - Home Health

CARELON-physical-therapy-occupational-therapy-and-speech-therapy-2024-04-14 — Physical Therapy Occupational Therapy and Speech Therapy

BCBSIL-MED201.027 — Electrostimulation and Electromagnetic Therapy for Treating Wounds

BCBSMT-MED201.027 — Electrostimulation and Electromagnetic Therapy for Treating Wounds

BCBSNM-MED201.027 — Electrostimulation and Electromagnetic Therapy for Treating Wounds

BCBSOK-MED201.027 — Electrostimulation and Electromagnetic Therapy for Treating Wounds

BCBSIL-THE803.010 — Physical Therapy (PT) and Occupational Therapy (OT) Services

`G0281` — Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G0281 — Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G0281` — Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care