Does S9353 require prior authorization?

No, S9353 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for S9353?

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

Verity

`S9353` — Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

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

For intrathecal baclofen: 'The patient should be shown to respond to a single intrathecal bolus dose of up to 100 mcgs of baclofen. A positive response is defined as an average two-point drop on an objective muscle tone or spasm screening system (e.g., The Ashworth and Spasm scale).'

Pre-implantation requirements for spinal analgesia: 'To be considered for spinal analgesia, a patient must have a normal platelet count and no coagulation disorder, infection, or other problems that might preclude the use of spinal drugs.'

Intrahepatic chemotherapy: documentation supporting diagnosis of primary hepatocellular carcinoma or metastatic colorectal cancer limited to the liver and clinical justification for intrahepatic infusion.

Trialing before permanent intrathecal pump implantation: 'Before the implantation of a permanent infusion system, an efficacy test is usually performed to assess the patient's response and dose. One or several trial doses of 5 to 10 mg of epidural morphine, or 0.5 to 1.0 mg intrathecal morphine is/are administered while all other analgesic medications are stopped. Subjective pain ratings and undesirable side effects are evaluated for several days.'

Key Coverage Criteria

G89.4 Chronic pain syndrome
G95.11 - G95.19 Vascular myelopathies
O88.011 - O88.83 Obstetric embolism
External infusion pumps (only) for deferoxamine for treatment of acute iron poisoning and iron overload.
G82.50 - G82.54 Quadriplegia
Implanted infusion pumps are medically necessary durable medical equipment (DME) when: the drug is medically necessary for the treatment of the member; it is medically necessary that the drug be administered by an implanted infusion pump; and the infusion pump has been approved by the FDA for infusion of the particular drug that is to be administered.

3 Active Policies

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

AETNA-CPB-0161 — Infusion Pumps

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

`S9353` — Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

S9353 — Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

`S9353` — Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem