Does G0259 require prior authorization?

Yes, G0259 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for G0259?

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

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`G0259`, Injection procedure for sacroiliac joint; arthrography

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

See appendix for additional details on documentation requirements (policy references an appendix)
All medical necessity criteria must be clearly documented in the member's medical record and made available upon request.

Billing rule: For continuous intraoperative neurophysiology monitoring in the operating room with one-on-one monitoring requiring personal attendance, increments of less than 8 minutes should not be billed.

Coverage is contingent on 'selection criteria are met' for each modality (EMG, SSEP, BAER) — the policy repeatedly requires that selection criteria be met for coverage (the specific selection criteria are referenced but not detailed in this text chunk).

No explicit detailed documentation checklist (e.g., required operative/progress notes, test results, or preauthorization items) is provided in this extracted text; however, coverage statements reference specific ICD-10 diagnosis codes and CPT/HCPCS procedure codes which must be present to support medical necessity.

Key Coverage Criteria

Intraoperative EMG monitoring of the facial nerve during surgery for cholesteatoma, including mastoidotomy or mastoidectomy
ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "H93.3x1 - H93.3x9" Disorders of acoustic nerve [compression].
ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "I06.0 - I06.9" Diseases of aortic valve.
ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "I35.0 - I35.9" Nonrheumatic aortic valve disorders.
ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "I70.0" Atherosclerosis of aorta.
ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "I71.00 - I71.9" Dissection of aorta.

3 Active Policies

EVICORE-HPLAN-AETNA-E6DAD43A2777, Aetna Interventional Pain Code List - Effective 01/01/2025

EVICORE-HPLAN-HAP-AB9D421BCDBD, Health Alliance Plan MSK Code List - Effective 01/01/2026

AETNA-CPB-0697, Intraoperative Neurophysiological Monitoring

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G0259, Injection procedure for sacroiliac joint; arthrography