Does J0834 require prior authorization?

Yes, J0834 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for J0834?

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

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`J0834`, Injection, cosyntropin, 0.25 mg

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

Documentation that a neurological cause for the pain cannot be detected (clinical/neurological evaluation).
Documentation of failure of prior conservative treatments, specifically: high-fiber diet; withdrawal of drugs that cause constipation (e.g., calcium channel blockers, narcotics) or diarrhea (e.g., antibiotics, quinidine, theophylline); perineal strengthening exercises; rectal massage; warm baths; and drug therapy (e.g., muscle relaxants, non-narcotic analgesics, and sedatives).

Documentation that no underlying disease has been revealed by anorectal examination or by manometry, radiology, or endoscopy (reports/results from anorectal exam, manometry, radiologic studies, endoscopy as applicable).

Treatment records documenting number of sessions, session duration (to ensure ≤ three 60-minute sessions within a 10-day period for medical necessity), settings used, and patient tolerance/response.

For biofeedback, documentation that the same selection criteria (as above) are met and adherence to CPB 0132 - Biofeedback requirements (as applicable).

Key Coverage Criteria

Aetna considers biofeedback medically necessary for members with refractory levator syndrome when criteria listed above are met. (See CPB 0132 - Biofeedback).
CPT codes covered if selection criteria are met: 97014 (electrical stimulation unattended), 97032 (electrical stimulation, manual, each 15 minutes).
HCPCS code covered if selection criteria are met: E0746 (Electromyography (EMG), biofeedback device).
ICD-10 codes covered if selection criteria are met: K59.4 (Anal spasm [proctalgia fugax]) and K62.89 (Other specified diseases of anus and rectum [chronic anal pain syndrome] [levator syndrome or chronic anal pain syndrome]).
Biofeedback is medically necessary for members with refractory levator syndrome when the same criteria listed for HVPGS are met. (See CPB 0132 - Biofeedback.)
High-voltage pulsed electrogalvanic stimulation (HVPGS) is medically necessary for members with refractory levator syndrome (also known as proctalgia fugax, chronic anal pain syndrome) when ALL the following criteria are met: a neurological cause for the pain can not be detected; member has failed prior conservative treatments (high-fiber diet, withdrawal of drugs that cause constipation [e.g., calcium channel blockers, narcotics] or diarrhea [e.g., antibiotics, quinidine, theophylline], perinea [...]

2 Active Policies

HEALTHNET_OR-HNOR-COSYNTROPIN-CORTROSYN-CP-PHAR-203-5FDE7690FA, Cosyntropin (Cortrosyn); CP.PHAR.203

AETNA-CPB-0679, Levator Syndrome Treatments

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J0834, Injection, cosyntropin, 0.25 mg