Does J0461 require prior authorization?

No, J0461 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for J0461?

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

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Use CPT codes 78472, 78473, 78481, 78483, 78494, or 78496 when billing cardiac blood pool imaging (MUGA, ventriculography).
When applicable, include the additional secondary code indicating personal history of malignant neoplasm (Z85 series) per Correct Coding Initiative (CCI) guidelines alongside the appropriate C-code or D-code family entry.
Refer to the policy's Covered ICD-10 Codes section to select the appropriate C-code, D-code, and Z85 family codes for billing cardiac blood pool imaging.
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.

Cardiac blood pool imaging (MUGA, ventriculography) is covered when performed for patients receiving cardiotoxic chemotherapy.
Cardiac blood pool imaging is covered for evaluation of valvular disease or cardiomyopathies.
Prior to initiation of cardiotoxic chemotherapy, bill cardiac blood pool imaging with ICD-10 code Z01.89 plus the appropriate C-code or D-code family entry.
During or for interval assessment while receiving cardiotoxic chemotherapy, bill using the appropriate T45.1X5* encounter code (T45.1X5A, T45.1X5D, or T45.1X5S) to indicate ongoing exposure.
At completion of cardiotoxic chemotherapy, bill cardiac blood pool imaging with ICD-10 code Z08 and the appropriate C-code or D-code family entry.
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.

CGS-L34338, Transthoracic Echocardiography (TTE)

J15

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

PALMETTO-JJ-L37379, Echocardiography

NGS-L33577, Transthoracic Echocardiography (TTE)

PALMETTO-JM-L37379

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