Does A9152 require prior authorization?

No, A9152 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for A9152?

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

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`A9152`, Single vitamin/mineral/trace element, oral, per dose, not otherwise specified

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Coverage determinations in each specific instance require consideration of: 1) the terms of the applicable benefit plan document in effect on the date of service; 2) any applicable laws/regulations; 3) any relevant collateral source materials including Coverage Policies; and 4) the specific facts of the particular situation.

Medical directors are expected to exercise clinical judgment where appropriate and have discretion in making individual coverage determinations.

When billing, providers must use the most appropriate codes as of the effective date of the submission.

Claims submitted for services that are not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered.

Reimbursement is not allowed for services when billed for conditions or diagnoses that are not covered under this Coverage Policy (see 'Coding Information').

Prescription medications are generally subject to a separate pharmacy benefit; coverage/exclusion of OTC vitamins, nutritional and dietary supplements may vary by plan.

Key Coverage Criteria

Coverage for complementary and alternative testing and therapies varies across plans. Please refer to the customer's benefit plan document for coverage details.
For information on Acupuncture and Biofeedback, refer to the applicable Cigna Coverage Policies.
None explicitly stated in this document as covered. (No section labelled 'Covered Indications' or phrases such as 'Medicare covers...' were found in the provided text.)
Permanence is considered met when the treating physician, documented in the medical record, judges the impairment is reasonably expected to exceed 3 months (90 days).

2 Active Policies

REGENCE-AH05, Enteral and Oral Nutrition in the Home Setting

CIGNA-EN0086, Complementary and Alternative Medicine

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A9152, Single vitamin/mineral/trace element, oral, per dose, not otherwise specified