Does J0153 require prior authorization?

Yes, J0153 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for J0153?

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

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`J0153`, Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate

HCPCS/CPT

Prior Authorization

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Use CPT codes 78472, 78473, 78481, 78483, 78494, or 78496 when billing cardiac blood pool imaging (MUGA, ventriculography).
When applicable, include the additional secondary code indicating personal history of malignant neoplasm (Z85 series) per Correct Coding Initiative (CCI) guidelines alongside the appropriate C-code or D-code family entry.

Claims for stress tests performed as preoperative evaluation of asymptomatic, moderate-risk patients must include medical record documentation of at least one of: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.

Key Coverage Criteria

Cardiac blood pool imaging (MUGA, ventriculography) is covered when performed for patients receiving cardiotoxic chemotherapy.
Cardiac blood pool imaging is covered for evaluation of valvular disease or cardiomyopathies.
Prior to initiation of cardiotoxic chemotherapy, bill cardiac blood pool imaging with ICD-10 code Z01.89 plus the appropriate C-code or D-code family entry.
During or for interval assessment while receiving cardiotoxic chemotherapy, bill using the appropriate T45.1X5* encounter code (T45.1X5A, T45.1X5D, or T45.1X5S) to indicate ongoing exposure.
At completion of cardiotoxic chemotherapy, bill cardiac blood pool imaging with ICD-10 code Z08 and the appropriate C-code or D-code family entry.
Preoperative cardiac stress testing with radionuclide imaging for asymptomatic patients deemed at moderate risk is covered only if the medical record documents at least one of the following: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.

19 Active Policies

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L33960, Cardiovascular Nuclear Medicine

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NORIDIAN-JE-L34324, Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography

NORIDIAN-JF-L34324, Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography

PALMETTO-JJ-L37379, Echocardiography

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

PALMETTO-JM-L37379, Echocardiography

IBX-COMMERCIAL-08-01-26E-45817D62B0, Enzyme Replacement Therapy for Adenosine Deaminase Severe Combined Immune Deficiency (e.g., elapegademase-lvlr [Revcovi])

A56625, Billing and Coding: Echocardiography

A57183, Billing and Coding: Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography

A57306, Billing and Coding: Transthoracic Echocardiography (TTE)

A56494, Billing and Coding: Cardiovascular Nuclear Medicine

A56476, Billing and Coding: Cardiac Radionuclide Imaging

AMERIHEALTH-COMMERCIAL-08-01-26E-1BC32B374C, Enzyme Replacement Therapy for Adenosine Deaminase Severe Combined Immune Deficiency (e.g., elapegademase-lvlr [Revcovi])

A54768, Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy

`J0153`, Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

19 Active Policies

Related Codes

Have a follow-up question?

J0153, Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

19 Active Policies

Related Codes

Have a follow-up question?

`J0153`, Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate