Does A9579 require prior authorization?

No, A9579 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A9579?

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

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`A9579`, Injection, gadolinium-based magnetic resonance contrast agent, not otherwise

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

Baseline audiometric testing performed prior to administration of the osmotic diuretic and repeat audiometric testing at approximately 3 hours post-ingestion (and sometimes at 1 and 2 hours) — documentation of timing of tests relative to diuretic administration is required.
Record of the specific osmotic diuretic administered (glycerol, urea, or other), dose/route, and timing.

Audiometric results documenting objective pre- and post-diuretic measures (pure-tone thresholds and speech discrimination) and whether test met positive criteria: either a 10 dB or more improvement at two or more frequencies (250–2,000 Hz) OR a 12% or greater improvement in speech discrimination scores.

Clinical documentation justifying use of the dehydration test — specifically documentation demonstrating an 'atypical presentation' of Meniere's disease for which the dehydration test is being used to verify suspicion.

Key Coverage Criteria

Dehydration testing with glycerol, urea, or other osmotic diuretics to verify the suspicion of endolymphatic hydrops (Meniere's disease) — medically necessary ONLY in members with atypical presentations of this disease.
ICD-10 codes covered if selection criteria are met: H81.01-H81.09 (Meniere's disease).
ICD-10 codes covered if selection criteria are met: H81.10-H81.13 (Benign paroxysmal vertigo).
ICD-10 codes covered if selection criteria are met: H81.311-H81.399 (Other peripheral vertigo).
ICD-10 codes covered if selection criteria are met: H81.41-H81.49 (Vertigo of central origin).
ICD-10 codes covered if selection criteria are met: H83.01-H83.2X9 (Labyrinthitis).

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`A9579`, Injection, gadolinium-based magnetic resonance contrast agent, not otherwise

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

A9579, Injection, gadolinium-based magnetic resonance contrast agent, not otherwise

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

`A9579`, Injection, gadolinium-based magnetic resonance contrast agent, not otherwise