Does J2805 require prior authorization?

No, J2805 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J2805?

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

No explicit documentation requirements are stated in the policy
Policy references clinical data elements commonly used in interpretation (e.g., gallbladder ejection fraction values such as <40% or <35%, reproduction of biliary pain during CCK-CS, prior ultrasonography showing cholelithiasis), but the policy does not mandate specific documentation or test result thresholds as coverage preconditions

CPT codes covered if selection criteria are met: 78226 (Hepatobiliary system imaging, including gallbladder when present)
ICD-10 codes covered if selection criteria are met: K82.A1 - K82.A2 (Disorders of gallbladder in diseases classified elsewhere)
ICD-10 codes covered if selection criteria are met: K83.1 (Obstruction of bile duct [common])
ICD-10 codes covered if selection criteria are met: K83.4 (Spasm of sphincter of Oddi)
CPT codes covered if selection criteria are met: 78227 (with pharmacologic intervention, including quantitative measurement(s) when performed)
HCPCS codes covered if selection criteria are met: J2805 (Injection, sincalide, 5mcg)

Ask Backwork about documentation requirements, denial risks, or coverage in your state.