Does J1440 require prior authorization?

No, J1440 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for J1440?

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

Imaging and laboratory/biomarker data used in studies: brain CT or MRI, amyloid PET (e.g., florbetapir), cerebrospinal fluid (CSF) biomarkers (Aβ1-42, total tau, phospho-tau), and APOE ε4 genotyping when reported in trials.
For some interventional procedures/trials, pre-procedure evaluations included medical/neurological and psychological examinations, depression rating scales (e.g., Montgomery–Asberg Depression Rating Scale), and lumbar puncture with CSF analysis.
Documentation of prior/concurrent standard therapies (e.g., use of cholinesterase inhibitors and/or memantine) is often recorded in trials and may be relevant when considering investigational add-on therapies.
None specified in this policy document. (The CPB lists investigational/experimental treatments and codes not covered; it does not define separate documentation requirements for coverage of the listed items.)

Rebyota is medically necessary for prevention of the recurrence of CDI in patients who meet all of the following criteria: diagnosis of recurrent CDI with diarrhea (3+ loose stools in 24h for 2 consecutive days) and positive stool test for C. difficile toxin; age 18+; at least one prior CDI recurrence; completed at least 10 days of oral vancomycin or fidaxomicin within 24-72 hours prior to Rebyota; previous CDI under control (less than 3 unformed stools/day for 2 consecutive days); and prescribe [...]
None specified. This Clinical Policy Bulletin addresses experimental treatments for Alzheimer's disease and lists treatments considered experimental and investigational (i.e., not established as effective) for this indication.
No explicit covered indications are stated in this document. The document discusses potential therapeutic use in the following conditions:
Alzheimer's disease (AD)
mild cognitive impairment (MCI)
amnestic MCI

UHC-POL-rebyota, Rebyota (Fecal Microbiota, Live-Jslm)

AETNA-CPB-0788, Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments

BCBSIL-SUR703.049, Fecal Microbiota Transplantation (FMT)

BCBSMT-SUR703.049, Fecal Microbiota Transplantation (FMT)

BCBSNM-SUR703.049, Fecal Microbiota Transplantation (FMT)

Ask Verity about documentation requirements, denial risks, or coverage in your state.