Does G0337 require prior authorization?

No, G0337 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G0337?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 1.42.

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Work RVU

1.42

Facility

N/A

Non-Facility

N/A

Required documentation (as specified in Criteria I) must be submitted.
Documentation demonstrating terminal diagnosis and expected life expectancy of six months or less.

Documentation of hospice medical director certification of hospice appropriateness for the initial 90-day certification period

Written certification must identify the terminal illness diagnosis that prompted the member/enrollee to seek hospice care

Documentation of clinical findings that support a life expectancy of six months or less if the terminal diagnosis follows its normal course.

Hospice election statement signed by the member/enrollee or the member/enrollee’s healthcare proxy indicating understanding of hospice care.

Hospice care for members/enrollees with a terminal diagnosis and an expected life expectancy of six months or less, focused on relieving pain and symptoms related to the terminal diagnosis.
Hospice is considered medically necessary when the requirements in Criteria I (Required Documentation), II (severity of illness), and III are met.
Cancer as a terminal diagnosis warranting hospice care
Amyotrophic Lateral Sclerosis (ALS) as a terminal diagnosis warranting hospice care
Heart disease as a terminal diagnosis warranting hospice care
Pulmonary disease as a terminal diagnosis warranting hospice care

AMBETTER-CP.MP.54, Hospice Services

Ask Backwork about documentation requirements, denial risks, or coverage in your state.