Does J1250 require prior authorization?

No, J1250 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J1250?

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

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`J1250`, Injection, dobutamine hydrochloride, per 250 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

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.

18 Active Policies

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L33960, Cardiovascular Nuclear Medicine

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

A56625, Billing and Coding: Echocardiography

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

A57306, Billing and Coding: Transthoracic Echocardiography (TTE)

L33794, External Infusion Pumps

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

A56476, Billing and Coding: Cardiac Radionuclide Imaging

A56494, Billing and Coding: Cardiovascular Nuclear Medicine

`J1250`, Injection, dobutamine hydrochloride, per 250 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

18 Active Policies

Related Codes

Have a follow-up question?

J1250, Injection, dobutamine hydrochloride, per 250 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

18 Active Policies

Related Codes

Have a follow-up question?

`J1250`, Injection, dobutamine hydrochloride, per 250 mg