Does A4559 require prior authorization?

No, A4559 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A4559?

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

Backwork Sign up free

`A4559`, Coupling gel or paste, for use with ultrasound device, per oz

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

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted for the item; claims without a completed SWO shall be denied.
For DMEPOS base items that require a Written Order Prior to Delivery (WOPD), the supplier must have a signed WOPD before delivering the item; the WOPD may list associated options/accessories/supplies.

Nonunion of a long-bone fracture must be documented by a minimum of two sets of radiographs obtained prior to starting treatment, separated by at least 90 days, each with multiple views of the fracture site and a treating practitioner’s written interpretation stating no clinically significant evidence of healing between the two sets.

For refills, the supplier must contact the beneficiary (no sooner than 30 calendar days prior to expected end of current supply), document an affirmative response, and deliver the refill no sooner than 10 calendar days prior to expected end of current supply.

Key Coverage Criteria

Non-spinal electrical osteogenesis stimulator (HCPCS E0747) is covered for nonunion of a long-bone fracture when there is radiographic evidence that fracture healing has ceased for at least 3 months prior to starting treatment.
Non-spinal electrical osteogenesis stimulator (HCPCS E0747) is covered for failed fusion of a joint other than the spine when a minimum of 9 months has elapsed since the last surgery.
Non-spinal electrical osteogenesis stimulator (HCPCS E0747) is covered for congenital pseudarthrosis.
Spinal electrical osteogenesis stimulator (HCPCS E0748) is covered for failed spinal fusion when a minimum of 9 months has elapsed since the last spinal surgery.
Spinal electrical osteogenesis stimulator (HCPCS E0748) is covered when used following a multilevel spinal fusion surgery.
Spinal electrical osteogenesis stimulator (HCPCS E0748) is covered following spinal fusion surgery when there is a history of a previously failed spinal fusion at the same site.

Have a follow-up question?

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

Ask Backwork about A4559 Sign up free

`A4559`, Coupling gel or paste, for use with ultrasound device, per oz

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

A4559, Coupling gel or paste, for use with ultrasound device, per oz

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

`A4559`, Coupling gel or paste, for use with ultrasound device, per oz