Does S9433 require prior authorization?

No, S9433 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for S9433?

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

Clinical or genetic diagnostic documentation confirming the child has a disease/syndrome/disorder that includes low tone neuromuscular impairment, neurological impairment, or cognitive impairment.
A written order from the prescribing physician stating the amino-acid–based elemental formula is medically necessary.
Written order from the prescribing physician stating the amino-acid based formula is medically necessary for treatment of the enrollee.
Physician or licensed pediatric provider prescription/order for human breast milk or human donor milk.

Oral enteral nutrition (oral feeding) is consideredmedically necessarywhenallof the following criteria are met:
The product constitutes more than 50 percent of the individualâs caloric intake;and
The product must be a medical food for oral feeding;and
The product must be labeled and used for the dietary management of a specific medical disorder, disease, or condition for which there are distinctive nutritional requirements to avert the development of serious physical or mental disabilities or to promote normal development or function as listed in 1.or2. [...]
Conditions associated with an in-born error of metabolism that interfere with the metabolism of specific nutrients, including, but not limited to:Phenylketonuria (PKU);orHomocystinuria;orMethylmalonic acidemia;or
Phenylketonuria (PKU);or

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

UHC-POL-enteral-nutrition, Enteral Nutrition (Oral and Tube Feeding)

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.