Does A4596 require prior authorization?

Yes, A4596 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for A4596?

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

HCPCS/CPT

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

The plan of care should be ongoing (i.e., updated as the patient's condition changes), and treatment should demonstrate reasonable expectation of improvement.
"A reasonable estimate of when the goals will be reached;"

ICD-10 G92.00 - G92.9 Toxic encephalopathy (covered if selection criteria are met).
Rehabilitation for visuo-spatial deficits (generally entails 20 1-hour sessions delivered over the course of 4 weeks).
Rehabilitation for language and communication deficits (persons usually receive 8 hours of weekly therapy, beginning at 4 weeks post-onset and continuing up to 48 weeks post-onset).
Cognitive rehabilitation is considered medically necessary for encephalopathy due to HIV when medical necessity criteria in section I above are met.
ICD-10 F07.81 Postconcussion syndrome (covered if selection criteria are met).
Cognitive rehabilitation as adjunctive treatment of cognitive deficits (e.g., attention, language, memory, reasoning, executive functions, problem solving, and visual processing) when performed by a licensed health care professional acting within their scope of practice and all of the following are met: Neuropsychological testing has been performed and neuropsychological results will be used in treatment-planning and directing rehabilitation strategies; and The cognitive deficits have been acqui [...]

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