Does J2785 require prior authorization?

No, J2785 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J2785?

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

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`J2785`, Injection, regadenoson, 0.1 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

The patient's medical record must include the ordering provider's assessment related to the patient's complaint for that visit.
The medical record must include relevant medical history and results of pertinent tests and procedures.

Office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.

When using the -GA modifier and ABN, Form CMS-R-131 must be signed by the beneficiary (or properly witnessed if the beneficiary refuses to sign) to indicate acceptance of payment responsibility.

For claims submitted to the Part A MAC that include an ABN, occurrence code 32 and the date of the ABN must be reported on the claim.

Refer to National Correct Coding Initiative (NCCI) edits and OPPS packaging edits to determine appropriate procedure coding before billing Medicare.

Key Coverage Criteria

For services that require a referring or ordering physician, the claim must report the referring/ordering physician's name and NPI.
Claims must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the service was performed; otherwise the claim will be returned as incomplete under SSA Section 1833(e).
For diagnostic tests, the claim should report the test result if known, otherwise report the symptoms that prompted the test.
If a service is likely to be non-covered, an Advance Beneficiary Notice (ABN) may be used and the appropriate modifier (GA, GX, GY, or GZ) should be appended to the claim as applicable.
Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.

9 Active Policies

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L33960, Cardiovascular Nuclear Medicine

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

A56494, Billing and Coding: Cardiovascular Nuclear Medicine

A57306, Billing and Coding: Transthoracic Echocardiography (TTE)

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J2785, Injection, regadenoson, 0.1 mg