Does G0138 require prior authorization?

No, G0138 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G0138?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.21.

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Work RVU

0.21

Facility

N/A

Non-Facility

N/A

Taliglucerase alfa (Elelyso) is covered for individuals ≥4 years with confirmed Type 1 Gaucher disease.
Velaglucerase alpha (VPRIV) is covered for long-term ERT in individuals ≥4 years with Type 1 Gaucher disease.
Vestronidase alfa-vjbk (Mepsevii) is covered for individuals with MPS VII (Sly syndrome).
Agalsidase beta (Fabrazyme) is covered when the member is ≥2 years old and has a confirmed diagnosis of Fabry disease.
Avalglucosidase alfa-NGPT (Nexviazyme) is covered for individuals ≥1 year with late-onset Pompe disease (GAA deficiency).
Idursulfase (Elaprase) is covered for individuals ≥5 years with a diagnosis of Hunter's syndrome (MPS II).