Does G0269 require prior authorization?

No, G0269 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G0269?

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

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`G0269`, Placement of occlusive device into either a venous or arterial access site,

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

The patient's medical record must fully document medical necessity for the cardiac catheterization and support the diagnosis and procedures billed.
Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and reason for the procedure and these codes must be linked to the CPT procedure codes on the claim.

When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim; for extra-cardiac angiographic services the treating physician's name and NPI must be submitted in items 17/17a of CMS-1500 or electronic equivalent.

For patients post-heart transplant without evidence of rejection, use primary diagnosis Z09 (follow-up after completed treatment) and secondary diagnosis Z94.1 (heart transplant status); add the underlying disorder code when coding I25.82 or I31.4.

Key Coverage Criteria

Medicare Part B covers the professional component of cardiac catheterization and coronary angiography when performed in hospital inpatient and outpatient facility settings.
Diagnostic cardiac catheterization performed in an office setting (where permitted) is covered under Medicare Part B for both professional and technical components.
Global and technical component procedures are covered under Part B when performed under personal physician supervision in an IDTF, free-standing facility, physician office, or physician-directed clinic (physician present in room for entire procedure).
Cardiac catheterization and coronary angiography are covered when the medical record documents medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests that support the procedure.
Right heart catheterization is indicated for endocarditis requiring valvular surgical repair.
Right heart catheterization is indicated for suspected rejection of a transplanted heart.

6 Active Policies

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

NGS-J6-L33557, Cardiac Catheterization and Coronary Angiography

A52850, Billing and Coding: Cardiac Catheterization and Coronary Angiography

NGS-JK-L33557, Cardiac Catheterization and Coronary Angiography

A56500, Billing and Coding: Cardiac Catheterization and Coronary Angiography

`G0269`, Placement of occlusive device into either a venous or arterial access site,

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

G0269, Placement of occlusive device into either a venous or arterial access site,

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

`G0269`, Placement of occlusive device into either a venous or arterial access site,