Does S8085 require prior authorization?

Yes, S8085 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for S8085?

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

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation: Providers may need to submit clinical documentation reflecting the clinical situation and the ordering provider’s intent.

Advanced imaging is considered medically necessary for the diagnosis of an incidentaloma greater than or equal to 5 mm that is not a simple cyst.
Annual surveillance imaging for microadenoma measuring 10 mm or less.
Baseline imaging within the first year after gross total resection, with follow-up imaging at 2, 5, and 10 years.
Imaging for incidental pituitary lesion of at least 10 mm (not a simple cyst).
Initial imaging for macrocephaly in infants under 5 months should be ultrasound.
PET brain imaging is medically necessary for epilepsy refractory to optimal medical management in surgical candidates.

CARELON-imaging-of-the-brain-2024-10-20, Imaging of the Brain

CARELON-imaging-of-the-brain-2025-11-15-updated-2026-01-01, Imaging of the Brain

CARELON-imaging-of-the-extremities-2024-10-20, Imaging of the Extremities

CARELON-imaging-of-the-extremities-2025-11-15, Imaging of the Extremities

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