Does S9208 require prior authorization?

No, S9208 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for S9208?

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

Verity

`S9208` — Home management of preterm labor, including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation of the diagnosis of preterm labor (e.g., ICD-10 O60.02 - O60.03) and gestational age (after 22 weeks but before 37 weeks) when applicable.
Clinical documentation that the pregnant woman is at risk of preterm delivery within 7 days (to support use of magnesium sulfate for short-term prolongation up to 48 hours).

Documentation of the specific clinical purpose for magnesium sulfate administration (e.g., to allow administration of antenatal corticosteroids, fetal neuroprotection, or prevention/treatment of eclampsia/preeclampsia).

When billing CPT/HCPCS codes that are noted 'covered if selection criteria are met' or 'exception basis only', maintain records supporting that selection criteria/exception rationale were met (medical record notes, justification for home infusion or pump use, and any prior authorization or exception documentation if required).

Key Coverage Criteria

Aetna considers magnesium sulfate injections medically necessary for short-term prolongation of pregnancy (up to 48 hours) in pregnant women who are at risk of preterm delivery within 7 days.
Prevention and treatment of seizures in women with preeclampsia or eclampsia (as supported by ACOG/SMFM Committee Opinion on magnesium sulfate use in obstetrics).
Fetal neuroprotection before anticipated early preterm (less than 32 weeks of gestation) delivery (as supported by ACOG/SMFM Committee Opinion on magnesium sulfate use in obstetrics).
Short-term prolongation of pregnancy (up to 48 hours) to allow for the administration of antenatal corticosteroids in pregnant women who are at risk of preterm delivery within 7 days (as supported by ACOG/SMFM Committee Opinion on magnesium sulfate use in obstetrics).
Covered diagnosis codes (ICD-10) when selection criteria are met: O60.02 - O60.03 (Preterm labor without delivery [after 22 weeks but before 37 weeks]).

`S9208` — Home management of preterm labor, including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

S9208 — Home management of preterm labor, including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

`S9208` — Home management of preterm labor, including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)