Does C1823 require prior authorization?

No, C1823 does not require prior authorization (high confidence). Covered without prior authorization.

`C1823`, Generator, neurostimulator (implantable), non-rechargeable, with transvenous

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Diaphragmatic/Phrenic StimulationDiaphragmatic/phrenic nerve stimulation with an FDA-approved device is consideredmedically necessaryas an alternative to invasive mechanical ventilation for individuals who are 18 years of age or older when ALL of the following criteria are met:The individual has ventilatory failure from stable, high spinal cord injuryorventilatory failure from central alveolar hypoventilation syndrome;andThe individual cannot breathe spontaneously for 4 continuous hours or more [...]
The individual has ventilatory failure from stable, high spinal cord injuryorventilatory failure from central alveolar hypoventilation syndrome;and
The individual cannot breathe spontaneously for 4 continuous hours or more without use of a mechanical ventilator;and
Diaphragm movement with stimulation is visible under fluoroscopy;and
Stimulation of the diaphragm either directly or through the phrenic nerve results in sufficient muscle activity to accommodate independent breathing without the support of a ventilator for at least 4 continuous hours a day;and
Individual has normal chest anatomy, a normal level of consciousness, and has the ability to participate in and complete the training and rehabilitation associated with the use of the device;and

ANTHEM-CG-MED-79, Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems

BCBSIL-SUR701.042, Phrenic Nerve Stimulation for Central Sleep Apnea

BCBSMT-SUR701.042, Phrenic Nerve Stimulation for Central Sleep Apnea

BCBSNM-SUR701.042, Phrenic Nerve Stimulation for Central Sleep Apnea

BCBSOK-SUR701.042, Phrenic Nerve Stimulation for Central Sleep Apnea

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