Does S9097 require prior authorization?

No, S9097 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S9097?

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

Note:To be eligible for wound care in the home setting, the individual must be confined to the home as defined in CG-MED-23 Home Health.
Initial care for a chronic wound in the home or outpatient setting is consideredmedically necessarywhen:
The wound care is prescribed by the attending physician, health care provider practicing within the scope of license, or the primary care physician in coordination with the attending physician as part of a written plan of care;and
The wound care is so inherently complex that it can only be safely and effectively performed by or under the general supervision of a licensed medical professional (for example, but not limited to stage III or IV pressure ulcers, non-healing neuropathic ulcers, venous or arterial insufficiency related ulcers, persistent wounds);and
A complete, individualized wound care program appropriate to the type of wound being treated, which meetsallof the requirements below, has been initiated:Initial documentation in the individualâs medical record of evaluation, plan of care, wound care, wound characteristics, and wound measurements by a licensed medical professional;andApplication of dressings according to manufacturer guidelines;andDebridement of necrotic tissue if present;andEvaluation of and provision for adequate nutritional [...]