Does S0145 require prior authorization?

Yes, S0145 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for S0145?

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

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`S0145`, Injection, pegylated interferon alfa-2a, 180 mcg per ml

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation confirming the scar's etiology is due to external trauma (examples: burn, blunt force trauma, penetrating trauma, laceration, surgical wound).
Documentation demonstrating functional impairment attributable to the scar (examples: restricted range of motion, lesion impacting a vital structure such as nose or eyes).

Clinical documentation of the specific modality(ies) being used (compression/pressure therapy, laser therapy, autologous soft tissue grafting, intralesional 5‑fluorouracil) and whether they are used as monotherapy or in combination.

For continued laser therapy beyond six initial treatments: successive objective measurements demonstrating beneficial clinical response (examples: range of motion measurements, vision testing) must be documented.

Evidence that the requested service meets the applicable benefit plan's terms, and any additional documentation required by the payer/plan (the policy states reimbursement requires submission in accordance with relevant criteria including covered diagnosis and/or procedure codes).

Key Coverage Criteria

Scar revision is considered medically necessary when ALL of the following criteria apply to the treated scar: (1) is due to a history of external trauma (e.g., burn, blunt force trauma, penetrating trauma, laceration, surgical wound); (2) is causing a functional impairment (e.g., restricted range of motion, lesion impacting a vital structure such as nose or eyes); AND (3) ANY of the following modalities is being utilized as monotherapy or combination therapy: compression/pressure therapy; laser [...]
Fractional ablative laser therapy (CPT 0479T, 0480T) for burn and traumatic scars for functional improvement when the above medical necessity criteria are met. (Note: an initial regimen of laser therapy includes up to six treatments.)
Grafting of autologous soft tissue (CPT 15769) for scar revision when the above medical necessity criteria are met.
Intralesional 5-fluorouracil (HCPCS J9190) for scar revision when the above medical necessity criteria are met.

3 Active Policies

EVICORE-HPLAN-CIGNA-729A536F50C8, Q3 - 2026 Cigna MedOnc Master Drug List.pdf

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-4BC80209CCC5, Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List

CIGNA-0328, Scar Revision

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S0145, Injection, pegylated interferon alfa-2a, 180 mcg per ml