Does S9473 require prior authorization?

No, S9473 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S9473?

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

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`S9473`, Pulmonary rehabilitation program, non-physician provider, per diem

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

Documentation Required

Clinical documentation supporting the diagnosis of Guillain-Barre syndrome (ICD-10 G61.0) and relevant clinical findings (onset, severity, ambulatory status, respiratory compromise, etc.) to justify use of IVIG or plasmapheresis per the referenced CPBs.
Medical records to support medical necessity for procedures/therapies billed with CPT/HCPCS codes listed as covered (e.g., 36514, 90283, J1561/J1566/J1568/J1569, S9473) including notes, test results, and treatment course consistent with the applicable CPB selection criteria.

Documentation that selection/medical necessity criteria in the referenced CPBs are met: CPB 0206 - Parenteral Immunoglobulins (for IVIG), CPB 0285 - Plasmapheresis/Plasma Exchange/Therapeutic Apheresis (for plasmapheresis), and CPB 0032 - Pulmonary Rehabilitation (for outpatient pulmonary rehab).

If a service is proposed that is listed as experimental/investigational in this CPB, documentation of investigational rationale will not substitute for coverage; such therapies are considered not medically necessary for GBS per this policy.

Key Coverage Criteria

Outpatient pulmonary rehabilitation program for patients with Guillain-Barre syndrome when criteria listed in CPB 0032 - Pulmonary Rehabilitation are met.
CPT/HCPCS codes covered if selection criteria are met: 36514 (Therapeutic apheresis; for plasma pheresis) and 90283 (Immune globulin (IgIV), human, for intravenous use).
Guillain-Barre syndrome (ICD-10: G61.0) — treatment of GBS
Intravenous immunoglobulin (IVIG) for the treatment of Guillain-Barre syndrome when criteria in CPB 0206 - Parenteral Immunoglobulins are met.
Plasmapheresis (therapeutic apheresis / plasma exchange) for the treatment of Guillain-Barre syndrome when criteria in CPB 0285 - Plasmapheresis/Plasma Exchange/Therapeutic Apheresis are met.
HCPCS codes covered if selection criteria are met: J1561, J1566, J1568, J1569 (immune globulin products) and S9473 (Pulmonary rehabilitation program, non-physician provider, per diem).

6 Active Policies

ANTHEM-CG-REHAB-03, Pulmonary Rehabilitation

AETNA-CPB-0732, Guillain-Barre Syndrome Treatments

BCBSIL-THE803.025, Outpatient Pulmonary Rehabilitation

BCBSMT-THE803.025, Outpatient Pulmonary Rehabilitation

BCBSNM-THE803.025, Outpatient Pulmonary Rehabilitation

BCBSOK-THE803.025, Outpatient Pulmonary Rehabilitation

`S9473`, Pulmonary rehabilitation program, non-physician provider, per diem

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

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S9473, Pulmonary rehabilitation program, non-physician provider, per diem

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

`S9473`, Pulmonary rehabilitation program, non-physician provider, per diem