Does J2598 require prior authorization?

No, J2598 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J2598?

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

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`J2598`, Injection, vasopressin, 1 unit

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

For DGUOK deficiency, documentation of neurological status is required to determine transplant benefit: "Long-term survival is best predicted by the absence of profound hypotonia, significant psychomotor retardation, or nystagmus. ... liver transplantation appears to be futile in the presence of specific neurological signs or symptoms in patients affected with DGUOK deficiency."

OrganOx metra device donor/organ criteria should be documented: donor type (DBD vs DCD), donor age (<= 40 years for DCD), functional warm ischemic time (<= 20 minutes), and macro-steatosis (<=15%): "It is suitable for liver grafts from donors after brain death (DBD), or liver grafts from donors after circulatory death (DCD) of less than or equal to 40 years of age, with less than or equal to 20 mins of functional warm ischemic time ..., and macro-steatosis of less than or equal to 15 %."

For candidate selection and prognostication in HCC, pre-transplant inflammatory markers (pre-transplant neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio) have prognostic associations and may be documented: "Elevated pre-transplant NLR had a close association with the overall survival ..." and "high PLR value was associated with a significant increase in recurrence after transplantation."

When considering non-invasive tests for recurrent fibrosis or acute cellular rejection after transplant, transient elastography (TE) values and their reported cut-offs have been described and should be documented if used: examples—"One study showed a cut-off point of greater than 7.9 kPa to define graft damage and less than 5.3 kPa to exclude graft damage"; "Cut-off points were defined as TE greater than 8.5 kPa, moderate-to-severe ACR ... The measurement of TE less than 4.2 kPa excluded the possibility of any ACR."

If EBV viral-load monitoring strategy is used to reduce PTLD risk, serial EBV-DNA viral load results and any immunosuppression adjustments should be documented: "In pediatric LT, an EBV-DNA viral load (EBV VL) monitoring strategy, including the reduction of immunosuppression, has led to a lower incidence of PTLD. ... monitoring EBV VL may reduce PTLD incidence after LT in adults; however, larger studies are needed."

When using machine perfusion (NMP/HMP/HOPE) or MARS, document device/procedure used, perfusion parameters, duration, and relevant viability markers (e.g., bile production, lactic acidosis clearance, perfusate injury markers) because these are used in trials and viability assessments: e.g., "Several case series have suggested parameters usable for liver viability testing during NMP-L including bile production and clearance of lactic acidosis."

Key Coverage Criteria

CPT codes covered if selection criteria are met: 47135 Liver allotransplantation; orthotopic; partial or whole, from cadaver or living donor, any age
Retransplantation following a failed liver transplant when the initial transplant was performed for a covered indication.
ICD-10 codes covered if selection criteria are met: E83.10, E83.19 Other and unspecified disorders of iron metabolism
ICD-10 codes covered if selection criteria are met: E83.110 - E83.119 Hereditary hemochromatosis
ICD-10 codes covered if selection criteria are met: E85.1 Neuropathic heredofamilial amyloidosis
Large, unresectable fibrolamellar hepatocellular carcinomas (HCCs).

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`J2598`, Injection, vasopressin, 1 unit

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

J2598, Injection, vasopressin, 1 unit

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

`J2598`, Injection, vasopressin, 1 unit