Does J7197 require prior authorization?

Yes, J7197 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for J7197?

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

HCPCS/CPT

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Policy content not provided; unable to determine required documentation, prior authorization, or forms for AICC claims—manual review of the full policy required.

Policy content not provided; unable to determine covered indications for AICC NCD 110.3—manual review of the full policy required.

HEALTHNET_OR-HNOR-ANTITHROMBIN-III-ATRYN-THROMBATE-III-CP-PHAR-564-702242C70E, Antithrombin III (ATryn, Thrombate III); CP.PHAR.564

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