Does A4301 require prior authorization?

No, A4301 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A4301?

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

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Clinical documentation of failure of or intolerance to conservative treatments (e.g., systemic medications, physical therapy, behavioral health interventions).
Records demonstrating compliance with prior treatment attempts for the condition.

Long-term management of select patients with intractable pain using an implanted intrathecal or epidural drug delivery system that delivers medication directly into the spinal fluid.
Preliminary trial of epidural or intrathecal opioid for chronic intractable pain of malignant origin when: inadequate response to or intolerable side effects from noninvasive methods of pain control (e.g., systemic opioids); life expectancy > 3 months; and no evidence of epidural metastatic lesion(s) or tumor encroachment of the thecal sac on imaging.
Preliminary trial of epidural or intrathecal opioid for chronic intractable pain of nonmalignant origin (e.g., failed back surgery syndrome, complex regional pain syndrome) when: the pathology for the pain has been identified and life expectancy > 3 months.
Chronic pain refractory to or unable to tolerate conservative treatments (systemic pharmacotherapy, physical therapy, behavioral health for pain, and other appropriate nonsurgical treatments).
Member has demonstrated compliance with previous attempts to treat the condition.
Psychological evaluation confirms that a mental health condition is not a major contributor to the chronic pain symptoms.

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