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 CPT 97032, document the type of electrical stimulation (including 'manual'/'attended'), area(s) treated, and if used for muscle weakness provide objective strength ratings and functional deficits; if used for pain provide pain rating, pain location, and effect on function.

For non-implantable pelvic floor stimulation, document cognitive intactness, patient motivation, and a failed documented trial of PME training (defined as no clinically significant improvement after 4 weeks of an ordered PME plan).

For wound-related modalities (HCPCS G0281, G0329), document that the ulcer (stage III/IV pressure, arterial, diabetic, venous stasis) has not demonstrated measurable signs of healing after 30 days of conventional care and include wound measurements and treatment history.

Key Coverage Criteria

Attended/manual electrical stimulation (CPT 97032) is covered when the qualified professional provides direct 1-on-1 patient contact to apply/manualy adjust stimulation (e.g., direct motor point stimulation, FES/NMES when combined with therapeutic exercise/neuromuscular reeducation/functional activities).
Non-implantable pelvic floor electrical stimulation delivered via vaginal or anal probes (reportable as CPT 97032) is covered for 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.
Unattended/supervised electrical stimulation provided as part of a therapy plan of care (HCPCS G0283) is covered for non-wound indications (e.g., TENS, IFC, cyclical muscle stimulation) when used to control pain and/or swelling and when objective/subjective improvement is documented.
Electromagnetic therapy (HCPCS G0329) is covered for chronic stage III and 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.
Unattended electrical stimulation for wound management (HCPCS G0281) is covered for chronic stage III and IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that have not shown measurable healing after 30 days of conventional care.
Traditional negative pressure wound therapy (NPWT) devices, units, and supplies are covered under the Durable Medical Equipment (DME) benefit when they meet DME LCD coverage criteria and medical necessity.

20 Active Policies

A55909 — Billing and Coding: Wound Care

J05

L37228 — Wound Care

J05

L33631 — Outpatient Physical and Occupational Therapy Services

J06

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

J06

CGS-L34049 — Outpatient Physical and Occupational Therapy Services

J18 MAC Part B

WPS-L37228 — Wound Care

J8 MAC Part B

NGS-L33631 — Outpatient Physical and Occupational Therapy Services

JK MAC Part B

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

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

BCBSMT-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