Does S2061 require prior authorization?

No, S2061 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S2061?

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

Oncology records showing absence of active malignancy or documentation of complete resection / assessment of low likelihood of recurrence and acceptable risk.
Functional status and rehabilitation records; documentation of ventilatory status and whether ambulatory ECMO is being used as a bridge-to-transplant.

Heart-lung transplantation is medically necessary for persons with severe refractory heart failure plus either end-stage lung disease or irreversible pulmonary hypertension when the selection criteria are met and no absolute contraindications are present.
Severe (New York Heart Association (NYHA) classification III or IV) heart failure where right ventricular function would not be restored with lung transplant alone.
Chronic obstructive pulmonary disease with severe heart failure.
Congenital heart disease associated with pulmonary hypertension that are not amenable to lung transplantation and repair by standard cardiac surgery.
Cystic fibrosis with severe heart failure.
Eisenmenger's complex with irreversible pulmonary hypertension and severe heart failure.

ANTHEM-MP-A053821, TRANS.00009 Lung and Lobar Transplantation

AETNA-CPB-0597, Heart-Lung Transplantation

BCBSIL-SUR703.010, Lung and Lobar Lung Transplant

BCBSMT-SUR703.010, Lung and Lobar Lung Transplant

BCBSNM-SUR703.010, Lung and Lobar Lung Transplant

BCBSOK-SUR703.010, Lung and Lobar Lung Transplant

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