Does G0329 require prior authorization?

No, G0329 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0329?

Medicare facility rate: $10.69. Non-facility rate: $10.69. Work RVU: 0.06.

Verity

`G0329` — Electromagnetic therapy, 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

0.06

Facility

$10.69

Non-Facility

$10.69

Documentation Required

The medical record must clearly document that the coverage indications, limitations, and medical necessity criteria in L37228 Wound Care have been met for any billed wound care item or service.
Documentation must support the specific CPT/HCPCS code(s) billed, including procedure details, depth and surface area for debridement codes, and rationale for the service.

If CPT 97597 or 97598 is billed by a therapist while the patient is under a Home Health benefit, coverage depends on inclusion in the Home Health plan of care; if billed by a physician or non-physician practitioner it is paid under Part B even if the beneficiary has an active Home Health plan.

Key Coverage Criteria

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.
CPT codes 97597, 97598, and wound debridement codes 11042-11047 may be covered when the medical record documents medical necessity consistent with L37228 Wound Care criteria and Medicare reasonable-and-necessary requirements.
Skilled therapy services are covered when the skills of a qualified therapist are necessary to improve the patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration.
Rehabilitative therapy is covered when therapist skills are necessary to safely and effectively furnish a recognized therapy service with the goal of improving an impairment or functional limitation.
Maintenance therapy is covered only when an individualized clinical assessment documents that specialized judgment, knowledge, and skills of a qualified therapist are necessary to perform the maintenance program safely and effectively.
Physical therapy (CPT 97161-97163) and occupational therapy (CPT 97165-97167) evaluations are covered; when an evaluation is the only service in an episode, the evaluation serves as the plan of care if it contains a diagnosis or a description sufficient for the referring physician/NPP to determine a diagnosis.

20 Active Policies

L37228 — Wound Care

J05

A55909 — Billing and Coding: Wound Care

J05

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

J06

L33631 — 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

A57311 — Billing and Coding: Physical Therapy - Home Health

L34427 — Outpatient Occupational Therapy

L34428 — Outpatient Physical Therapy

L34564 — Home Health Physical Therapy

L34049 — Outpatient Physical and Occupational Therapy Services

L33942 — Physical Therapy - Home Health

UMR-POL-UMR-electrical-stimulation-electromagnetic-therapy-wounds — Electromagnetic Therapy for Wounds

SUREST-POL-SUREST-electrical-stimulation-electromagnetic-therapy-wounds — Electromagnetic Therapy for Wounds

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

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

BCBSMT-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

`G0329` — Electromagnetic therapy, 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?

G0329 — Electromagnetic therapy, 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?

`G0329` — Electromagnetic therapy, 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