Does S8035 require prior authorization?

Yes, S8035 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for S8035?

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

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`S8035`, Magnetic source imaging

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Document rationale and baseline measures if pursuing complementary or investigational therapies (neurofeedback, dietary interventions, supplementation) and obtain informed consent discussing limited evidence and uncertainties.

When pharmacologic therapy is used, document medication trials, doses, response and adverse effects where relevant (discussion of stimulants, atomoxetine, bupropion, TCAs appears in the evidence review).

EndeavorRx: requirement implied in indication — documentation of patient age (8 to 12 years), ADHD subtype (primarily inattentive or combined-type), and a "demonstrated attention issue" measurable by computer-based testing (e.g., baseline computer-based attention testing).

AKL-T01 (as studied): documentation used in trials included psychiatric screening, ADHD ratings, baseline neuropsychological measures, and objective attentional performance measures such as the TOVA Attention Performance Index (API) with trial inclusion requiring TOVA API ≤ -1.8.

Extended-release methylphenidate (clinical use): documentation of adult ADHD diagnosis (trials enrolled adults diagnosed with ADHD); note that many trials excluded psychiatric co-morbidity so documentation of comorbid conditions and prior medication responses may affect applicability.

WAVi / qEEG: clinicians should document that a standard clinical evaluation was performed and that EEG/qEEG is not being used to "confirm" a diagnosis; if EEG/qEEG is performed it should be documented as part of a research protocol or as adjunctive information with explicit informed discussion of limitations and risk of misdiagnosis.

Key Coverage Criteria

"EndeavorRx is a digital therapeutic (video game-based) indicated to improve attention function as measured by computer-based testing in children aged 8 to 12 years with primarily inattentive or combined-type ADHD, who have a demonstrated attention issue."
EndeavorRx: "should be considered for use as part of a therapeutic program that may include clinician-directed therapy, medication, and/or educational programs, which further address symptoms of the disorder."
AKL-T01 (investigational digital therapeutic): indicated in study context to target attention and cognitive control in pediatric patients with ADHD (studied in children aged 8 to 12 years in STARS-ADHD RCT and aged 8 to 14 in adjunct study STARS-Adjunct).
AKL-T01 (study-specified objective inclusion): pediatric patients with confirmed ADHD and TOVA Attention Performance Index (API) scores of -1.8 and below (STARS-ADHD trial).
Extended-release methylphenidate: discussed as the "recommended 1st-line pharmacological treatment" for adults with ADHD (Cochrane review examined extended-release formulations in adults diagnosed with ADHD).
Tryptophan modulation: investigated in clinical trials for effects on ADHD-related symptoms (evidence insufficient; trials mainly used acute tryptophan depletion procedures).

6 Active Policies

ANTHEM-CG-MED-76, Magnetic Source Imaging and Magnetoencephalography

EVICORE-HPLAN-AETNA-5BB4F6E94100, Aetna Cardiology and Radiology Code List - Effective 01/01/2026

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-CFF312B0BB7B, Health Partners Plans Cardiology, Radiology, and Ultrasound Code List – Effective 07/01/2025

AETNA-CPB-0426, Attention Deficit/Hyperactivity Disorder

AETNA-CPB-0279, Magnetic Source Imaging/Magnetoencephalography

CIGNA-0447, Autism Spectrum Disorders/Pervasive Developmental Disorders: Assessment and Treatment

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S8035, Magnetic source imaging