Does J0665 require prior authorization?

No, J0665 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J0665?

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

Backwork Sign up free

`J0665`, Injection, bupivicaine, not otherwise specified, 0.5 mg

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation the member is not scheduled to undergo total knee replacement within 6 months of starting treatment.
Radiographic evidence of osteoarthritis of the knee (e.g., joint space narrowing, subchondral sclerosis, osteophytes and sub-chondral cysts) OR documentation that member has at least 5 of the specified signs/symptoms (bony enlargement; bony tenderness; crepitus on active motion; ESR < 40 mm/hr; < 30 minutes morning stiffness; no palpable warmth of synovium; age > 50; rheumatoid factor < 1:40 titer (agglutination method); synovial fluid clear with normal viscosity and WBC < 2000/mm3).

Documentation that knee pain interferes with functional activities (e.g., ambulation, prolonged standing).

Documentation of inadequate response or adverse effects with non-pharmacologic treatment options (e.g., physical therapy, regular exercise, insoles, knee bracing, weight reduction).

Documentation of inadequate response, intolerance, or contraindication to a trial of an analgesic (e.g., acetaminophen up to 3 to 4 grams/day, NSAIDs, topical capsaicin) for at least 3 months.

Documentation of inadequate response, intolerance, or contraindication to a trial of intra-articular steroid injections for at least 3 months.

Key Coverage Criteria

Bony enlargement
Over 50 years of age
Rheumatoid factor less than 1:40 titer (agglutination method)
Synovial fluid signs (clear fluid of normal viscosity and WBC less than 2000/mm3)
The member has knee pain which interferes with functional activities (e.g., ambulation, prolonged standing)
The member has experienced an inadequate response or adverse effects with non-pharmacologic treatment options (e.g., physical therapy, regular exercise, insoles, knee bracing, weight reduction)

1 Active Policy

AETNA-CPB-0179, Viscosupplementation

Have a follow-up question?

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

Ask Backwork about J0665 Sign up free

J0665, Injection, bupivicaine, not otherwise specified, 0.5 mg