Does H2027 require prior authorization?

No, H2027 does not require prior authorization (high confidence). No active policy covers this code.

What is the Medicare reimbursement rate for H2027?

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

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`H2027`, Psychoeducational service, per 15 minutes

HCPCS/CPT

Prior Authorization

No Prior Auth Required

No active policy covers this code (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation that the individual meets DSM-5 TR criteria for Autism Spectrum Disorder when behavioral health treatment is requested
Behavioral health evaluation / psychiatric diagnostic evaluation report (CPT 90791 / 90792) when applicable

Results and documentation of autism-specific developmental screening instruments (CPT 96110) and developmental test administration/interpretation reports (CPT 96112, 96113) when those services are billed

Key Coverage Criteria

Behavioral health evaluation including psychiatric examination for suspected or known ASD
Electroencephalogram (EEG) when there is suspicion of a seizure
Evaluation by speech and language pathologist
Lead screening (CPT 83655)
Autism-specific developmental screening (CPT 96110, e.g., CHAT, PDDST-II) and developmental tests (CPT 96112, 96113 e.g., ABC, CARS)
Neuroimaging studies when the child is a candidate for specific interventions such as epilepsy surgery

1 Active Policy

CIGNA-0447, Autism Spectrum Disorders/Pervasive Developmental Disorders: Assessment and Treatment

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H2027, Psychoeducational service, per 15 minutes