Does J1956 require prior authorization?

No, J1956 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J1956?

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

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

A course of up to 4 weeks of intravenous (IV) antibiotic therapy is consideredmedically necessaryfor individuals with Lyme disease meetingBOTHcriteria AandB below:
The condition to be treated isONEof the following (1, 2,or3):Myocarditis associated with any of the following:First-degree heart block when the PR interval is prolonged to 300 milliseconds or greater;orSecond-degree atrioventricular block;orThird-degree atrioventricular block;orPersistent or recurrent joint swelling (that is, arthritis) after an initial 1 month trial of oral antibiotics;orAcute or chronic neurological disease affecting the central or peripheral nervous system, includingANYof the [...]
Myocarditis associated with any of the following:First-degree heart block when the PR interval is prolonged to 300 milliseconds or greater;orSecond-degree atrioventricular block;orThird-degree atrioventricular block;or
First-degree heart block when the PR interval is prolonged to 300 milliseconds or greater;or
Second-degree atrioventricular block;or
Third-degree atrioventricular block;or