Does G2010 require prior authorization?

No, G2010 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G2010?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.18.

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`G2010`, Remote evaluation of recorded video and/or images submitted by an established

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.18

Facility

N/A

Non-Facility

N/A

Documentation Required

The medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.
Medical record must include relevant medical history, applicable comorbidities/medications, prior diagnostic imaging/testing results, prior therapy history for the same diagnosis, and results of pertinent tests/procedures.

Documentation must be legible, relevant, sufficient to justify medical necessity, and should paint a clear picture of impairments, functional limitations, prior functional level, and the skilled nature of treatment provided.

Key Coverage Criteria

Therapy services are covered when the medical record and claim consistently and accurately document that the services are covered and medically necessary.
Therapy is covered when the patient has impairments and functional limitations that require the unique skills of a clinician (therapist) to improve functioning.
Coverage requires an initial evaluation performed by a clinician that documents objective findings, baseline functional testing using standardized scales, realistic goals, and expected rehabilitation potential.
Services are covered when documentation provides objective measurements or assessment results that demonstrate clinical progress toward the patient's identified functional limitations.
Therapy is covered when documentation justifies the type, frequency, and duration of skilled therapy as medically necessary for the individual patient's condition.
Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.

5 Active Policies

CGS-J15-L34049, Outpatient Physical and Occupational Therapy Services

J15

CGS-J18-L34049, Outpatient Physical and Occupational Therapy Services

J18

A57067, Billing and Coding: Outpatient Physical and Occupational Therapy Services

A57311, Billing and Coding: Physical Therapy - Home Health

A58559, Billing and Coding: Independent Diagnostic Testing Facilities (IDTF)

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G2010, Remote evaluation of recorded video and/or images submitted by an established