Does G0166 require prior authorization?

Yes, G0166 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for G0166?

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

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`G0166`, External counterpulsation, per treatment session

HCPCS/CPT

Prior Authorization

Prior Auth Required

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

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Treatment plan indicating intended number of sessions (up to 35 sessions per course) and justification when repeat treatment is requested.
Documentation that the member has disabling chronic stable angina (New York Heart Association Class III or Class IV angina) per the Appendix (NYHA functional classification).

Documentation that the member is not readily amenable to surgical intervention such as PTCA or cardiac bypass and that at least one of the following applies: Their condition is inoperable; They are at high-risk of operative complications or post-operative failure; Their coronary anatomy is not readily amenable to such procedures; They have co-morbid states that create excessive risk.

For repeat courses: documentation that member meets medical necessity criteria for initial ECP; documentation that prior ECP resulted in a sustained improvement in symptoms defined as either a significant (greater than 25%) reduction in frequency of anginal symptoms or improvement by 1 or more anginal classes; and documentation that three or more months has elapsed from the prior ECP treatment.

Key Coverage Criteria

HCPCS codes covered if selection criteria are met: G0166 External counterpulsation, per treatment session
A course of up to 35 sessions of ECP for members who meet both of the following criteria: Members with disabling chronic stable angina (New York Heart Association Class III or Class IV angina) (see Appendix); and Members are refractory to maximum medical therapy and not readily amenable to surgical intervention such as percutaneous transluminal coronary angioplasty (PTCA) or cardiac bypass due to any of the following: Their condition is inoperable; or They are at high-risk of operative complicat [...]
Repeat courses of ECP for persons with chronic stable angina if all of the following criteria are met: Member meets medical necessity criteria for ECP in Section I.A. above; and Prior ECP has resulted in a sustained improvement in symptoms with: A significant (greater than 25 %) reduction in frequency of anginal symptoms; or Improvement by 1 or more anginal classes; and Three or more months has elapsed from the prior ECP treatment;
ICD-10 codes covered if selection criteria are met: I20.1 - I20.9 Angina pectoris [disabling, refractory to maximum medical therapy and not readily amenable to surgical intervention]
ICD-10 codes covered if selection criteria are met: I25.111 - I25.119 Atherosclerotic heart disease of native coronary artery with angina pectoris
ICD-10 codes covered if selection criteria are met: I25.701 - I25.709 Atherosclerosis of coronary artery bypass graft(s) with angina pectoris

8 Active Policies

ANTHEM-CG-MED-86, Enhanced External Counterpulsation in the Outpatient Setting

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-FFF78083B324, Cigna Commercial Other Services Code List - Effective 03/07/2026

AETNA-CPB-0262, Enhanced External Counterpulsation (EECP)

BCBSIL-MED202.050, External Counterpulsation (ECP) Therapy for Severe Angina

BCBSMT-MED202.050, External Counterpulsation (ECP) Therapy for Severe Angina

BCBSNM-MED202.050, External Counterpulsation (ECP) Therapy for Severe Angina

BCBSOK-MED202.050, External Counterpulsation (ECP) Therapy for Severe Angina

`G0166`, External counterpulsation, per treatment session

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

G0166, External counterpulsation, per treatment session

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

`G0166`, External counterpulsation, per treatment session