Does A2035 require prior authorization?

No, A2035 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for A2035?

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

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`A2035`, Corplex p or theracor p or allacor p, per milligram

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

Billing, coding, and documentation requirements (e.g., required medical record elements, coding guidance, prior authorization if applicable) are specified in LCD L39139 and accompanying billing guidance; review LCD L39139 for the exact documentation required for claims.
This billing and coding article references Local Coverage Determination LCD L39624 for coverage and documentation requirements for amniotic and placental-derived product injections/applications for musculoskeletal (non-wound) indications; the LCD text was not provided so specific documentation requirements cannot be extracted.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the medical record must be legible and include appropriate patient identification information and dates of service.
The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Key Coverage Criteria

Coverage for amniotic and placental-derived product injections/applications for musculoskeletal, non-wound indications is determined by Local Coverage Determination L39139; consult LCD L39139 for specific clinical indications and thresholds.
Coverage applies when the amniotic or placental-derived product injection/application meets the reasonable and necessary requirements of Local Coverage Determination L39877.
Amniotic and placental-derived product injections/applications are covered only when they meet the reasonable and necessary clinical requirements specified in LCD L39879 (Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound).
Amniotic membrane products (Affinity, AmnioBand Membrane, Biovance, EpiCord, Epifix, Grafix, NuShield) may be considered medically necessary for treatment of nonhealing diabetic lower-extremity ulcers.
Medically necessary use of allogeneic acellular dermal matrix products for breast reconstruction when there is insufficient tissue expander/implant coverage, or compromised/thin postmastectomy skin flaps at risk of dehiscence/necrosis, or undermined inframammary/lateral folds needing reestablishment.
Diabetic lower-extremity ulcers that are nonhealing may be treated with human amniotic membrane products (Affinity, AmnioBand Membrane, Biovance, EpiCord, Epifix, Grafix, NuShield) and may be considered medically necessary.

20 Active Policies

CGS-J15-L39575, Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J15

CGS-J18-L39575, Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J18

A59434, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

WPS-J5-L39624, Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A58893, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

NGS-J6-L39139, Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

WPS-J8-L39624, Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A59764, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

FIRST_COAST-L39877, Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

NORIDIAN-JE-L39116, Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

NORIDIAN-JF-L39116, Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

NOVITAS-JH-L39879, Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

NGS-JK-L39139, Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A59766, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

NOVITAS-JL-L39879, Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

BCBSIL-SUR704.011, Amniotic Membrane and Amniotic Fluid

BCBSIL-SUR704.012, Bioengineered Skin and Soft Tissue Substitutes

BCBSMT-SUR704.011, Amniotic Membrane and Amniotic Fluid

BCBSMT-SUR704.012, Bioengineered Skin and Soft Tissue Substitutes

BCBSNM-SUR704.011, Amniotic Membrane and Amniotic Fluid

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A2035, Corplex p or theracor p or allacor p, per milligram