Does M0076 require prior authorization?

No, M0076 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for M0076?

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

Claims must include documentation that the service met the reasonable and necessary requirements and other documentation elements as required by LCD L35010.
When billing non-covered trigger point injections, include the appropriate Medicare modifier on the claim per Medicare billing rules.
This billing and coding guidance complements Local Coverage Determination (LCD) L38745 for Platelet Rich Plasma; refer to LCD L38745 for specific clinical indications, coverage rules, and required documentation.
This article contains billing, coding, or guideline information that complements the LCD; specific documentation, prior authorization, or forms are not specified here and must be obtained from the LCD or payer.

Trigger point injections are covered when they meet the reasonable and necessary clinical criteria specified in Local Coverage Determination L35010.
This article does not list specific covered indications; coverage is determined by the referenced Local Coverage Determination (LCD) for Platelet Rich Plasma.
Refer to Local Coverage Determination L39023 for covered indications for platelet-rich plasma (PRP) injections for non-wound indications.
Platelet-rich plasma (PRP) used for treatment of chronic non-healing wounds is covered when it meets CMS National Coverage Determination (NCD) 270.3; bill using HCPCS G0460/G0465 accordingly.
HCPCS P9020 should be billed for one or more units of PRP transfused when used to treat conditions or coagulopathies for which PRP transfusion is indicated.
Platelet-rich plasma (PRP) is covered only when the service meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) L39068.

A58609 — Billing and Coding: Platelet Rich Plasma

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L38937 — Platelet Rich Plasma

J06

A58810 — Billing and Coding: Platelet Rich Plasma

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L39071 — Platelet Rich Plasma

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L35010 — Trigger Point Injections

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