Does A4438 require prior authorization?

No, A4438 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A4438?

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

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`A4438`, Adhesive clip applied to the skin to secure external electrical nerve

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Claims may require medical records documentation to assess whether the member meets the clinical criteria for coverage; however, documentation does not guarantee coverage.
Medical Records Documentation Used for Reviews

Key Coverage Criteria

The ReActiv8 Implantable Neurostimulation System is consideredmedically necessarywhenallof the following criteria are met:
Adult (age at least 18 years old);and
Diagnosis of lumbar multifidus muscle dysfunction;and
Chronic low-back pain that has lasted longer than 6 months;and
Chronic low-back pain is non-radicular and non-neuropathic in character, with clinical records indicating that other potential sources of chronic back pain have been ruled out;and
History of pain on at least half of the days in the previous year;and

8 Active Policies

ANTHEM-SURG.00158, Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain

UHC-POL-electrical-stimulation-treatment-pain-muscle-rehabilitation, Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation

BCBSIL-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

BCBSMT-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

BCBSNM-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

BCBSOK-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

UMR-POL-UMR-electrical-stimulation-treatment-pain-muscle-rehabilitation, Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation

SUREST-POL-SUREST-electrical-stimulation-treatment-pain-muscle-rehabilitation, Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation

`A4438`, Adhesive clip applied to the skin to secure external electrical nerve

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

A4438, Adhesive clip applied to the skin to secure external electrical nerve

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

`A4438`, Adhesive clip applied to the skin to secure external electrical nerve