Does S5497 require prior authorization?

No, S5497 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S5497?

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

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`S5497`, Home infusion therapy, catheter care / maintenance, not otherwise classified;

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

Key Coverage Criteria

I. Home health services are consideredmedically necessarywhenallof the followingcriteriaA through Dare met:
The individual is confined to the home:The individual’s overall physical/medical condition poses a serious and significant impediment to receiving intermittent or occasional, skilled, medically necessary services outside the home setting. In general, the condition of these individuals should be such that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort;andIf the individual does in fact leave the home, the absences from t [...]
The individual’s overall physical/medical condition poses a serious and significant impediment to receiving intermittent or occasional, skilled, medically necessary services outside the home setting. In general, the condition of these individuals should be such that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort;and
If the individual does in fact leave the home, the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment. The following are examples of acceptable medical and non-medical absences (these examples are not all-inclusive and are provided as a means to illustrate the kinds of infrequent or unique events an individual may attend):Medical absences to receive health care treatment, including but not limited to [...]

`S5497`, Home infusion therapy, catheter care / maintenance, not otherwise classified;

Prior Authorization

Medicare Pricing

Key Coverage Criteria

1 Active Policy

Related Codes

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S5497, Home infusion therapy, catheter care / maintenance, not otherwise classified;

Prior Authorization

Medicare Pricing

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

`S5497`, Home infusion therapy, catheter care / maintenance, not otherwise classified;