Does S9343 require prior authorization?

No, S9343 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for S9343?

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

Electrocardiogram (ECG) results to identify cardiac abnormalities (sinus bradycardia, signs of hypokalemia, arrhythmias) when clinically indicated.
Psychiatric assessment documentation for concurrent psychiatric illness, suicide risk assessment, and psychosocial evaluation.
For enteral (nasogastric) feeding/re-feeding: documentation of malnutrition status, indication for tube feeding, feeding protocol used, prophylactic phosphate supplementation if used, monitoring of refeeding syndrome parameters, and documentation of short-term weight gain and adverse events.
For pharmacotherapy: documentation of prior treatments and response (e.g., failure of psychotherapy or other agents where relevant), dosing/titration and monitoring of adverse effects (e.g., for lisdexamfetamine monitoring of vital signs, heart rate, weight; for topiramate monitoring cognitive effects and tolerability), and contraindications (e.g., bupropion contraindication for BN).

Treatment: Pharmacotherapy for the treatment of bulimia (e.g., selective serotonin reuptake inhibitors such as fluoxetine, tricyclic anti-depressants, trazodone, topiramate).
Treatment: Pharmacotherapy for the treatment of binge-eating disorder (e.g., lisdexamfetamine dimesylate (Vyvanse)). (Note: Coverage may be excluded under plans that exclude coverage of medications to decrease or increase weight. Please check benefit plan descriptions.)
Management of members with anorexia or bulimia (Medically Necessary services and procedures listed below).
Assessment: Blood count and serum chemistry (e.g., CBC, electrolytes, BUN/creatinine).
Assessment: Bone density measurement (for evaluation of anorexic members).
Assessment: Electrocardiography.

ANTHEM-CG-MED-08, CG-MED-08 Home Enteral Nutrition

AETNA-CPB-0511, Eating Disorders

MED201.011, Nutritional Support

BCBSIL-MED201.011, Nutritional Support

BCBSMT-MED201.011, Nutritional Support

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