Does G0554 require prior authorization?

No, G0554 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G0554?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.61.

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`G0554`, Each additional 20 minutes of monthly treatment management services directly

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.61

Facility

N/A

Non-Facility

N/A

Documentation Required

Check state regulations and the member contract for coverage details.

Key Coverage Criteria

Mobile-based health management applications are consideredmedically necessarywhenallof the following criteria in I and II have been met:
Criteria to evaluate the mobile software application (MSA):The MSA has been approved or cleared by the Food and Drug Administration (FDA);andThere is credible scientific evidence which permits reasonable conclusions regarding the impact of the MSA on health outcomes;andThe MSA has been proven materially to improve the net health outcome or be as beneficial as any established alternative;AND

Criteria to evaluate the appropriateness of the MSA for the individual:The MSA has been prescribed by a healthcare practitioner;andThere is documentation supporting that the MSA was ordered for a covered purpose such as preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and in accordance with generally accepted standards of medical practice;*andThe requested MSA is not primarily for the convenience of the individual, prescribing clinician, caregiver, or o [...]

18 Active Policies

ANTHEM-CG-ANC-08, Mobile Device-Based Health Management Applications

BCBSIL-PSY301.022, Digital Health Technologies for Attention Deficit/Hyperactivity Disorder

BCBSIL-PSY301.024, Digital Health Technologies: Diagnostic Applications

BCBSIL-PSY301.025, Digital Health Technologies: Therapeutic Applications

BCBSMT-PSY301.022, Digital Health Technologies for Attention Deficit/Hyperactivity Disorder

BCBSMT-PSY301.024, Digital Health Technologies: Diagnostic Applications

BCBSMT-PSY301.025, Digital Health Technologies: Therapeutic Applications

BCBSNM-PSY301.022, Digital Health Technologies for Attention Deficit/Hyperactivity Disorder

BCBSNM-PSY301.024, Digital Health Technologies: Diagnostic Applications

BCBSNM-PSY301.025, Digital Health Technologies: Therapeutic Applications

BCBSOK-PSY301.022, Digital Health Technologies for Attention Deficit/Hyperactivity Disorder

BCBSOK-PSY301.024, Digital Health Technologies: Diagnostic Applications

BCBSOK-PSY301.025, Digital Health Technologies: Therapeutic Applications

REGENCE-MED175, Digital Therapeutic Products

REGENCE-MED175.01, Digital Therapeutic Products for Attention Deficit Hyperactivity Disorder

REGENCE-MED175.03, Digital Therapeutic Products for Chronic Low Back Pain

REGENCE-MED175.05, Digital Therapeutic Products for Post-traumatic Stress Disorder and Panic Disorder

REGENCE-MED175.02, Digital Therapeutic Products for Substance Use Disorders

`G0554`, Each additional 20 minutes of monthly treatment management services directly

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

18 Active Policies

Related Codes

Have a follow-up question?

G0554, Each additional 20 minutes of monthly treatment management services directly

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

18 Active Policies

Related Codes

Have a follow-up question?

`G0554`, Each additional 20 minutes of monthly treatment management services directly