Does S9214 require prior authorization?

No, S9214 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for S9214?

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

Verity

`S9214` — Home management of gestational diabetes, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and 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

Record that home visits take place during the same period the infusion therapy is ordered/being administered.
Documentation of failed conservative treatments (oral and/or rectal medications and/or non‑pharmacological therapies).

Key Coverage Criteria

I. Home health services are consideredmedically necessarywhenallof the followingcriteriaA through Dare met:
The individual is confined to the home:The individual’s overall physical/medical condition poses a serious and significant impediment to receiving intermittent or occasional, skilled, medically necessary services outside the home setting. In general, the condition of these individuals should be such that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort;andIf the individual does in fact leave the home, the absences from t [...]
The individual’s overall physical/medical condition poses a serious and significant impediment to receiving intermittent or occasional, skilled, medically necessary services outside the home setting. In general, the condition of these individuals should be such that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort;and
If the individual does in fact leave the home, the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment. The following are examples of acceptable medical and non-medical absences (these examples are not all-inclusive and are provided as a means to illustrate the kinds of infrequent or unique events an individual may attend):Medical absences to receive health care treatment, including but not limited to [...]
Medical absences to receive health care treatment, including but not limited to:Ongoing receipt of outpatient kidney dialysis;orReceipt of outpatient chemotherapy or radiation therapy;orParticipation in psychosocial or medical treatment in an adult day-care program that is licensed or certified by a state, or accredited, to furnish adult day-care services;or
Ongoing receipt of outpatient kidney dialysis;or

2 Active Policies

AMBETTER-CP.MP.91 — Obstetrical Home Care Programs

ANTHEM-CG-MED-23 — CG-MED-23 Home Health

`S9214` — Home management of gestational diabetes, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and 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

2 Active Policies

Related Codes

Have a follow-up question?

S9214 — Home management of gestational diabetes, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and 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

2 Active Policies

Related Codes

Have a follow-up question?

`S9214` — Home management of gestational diabetes, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)