Does S9476 require prior authorization?

No, S9476 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S9476?

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

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`S9476`, Vestibular 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

Diagnosis of BPPV documented by a positive Hallpike (Dix-Hallpike) maneuver: 'The Hallpike maneuver ... when positive, is diagnostic of BPPV.'
For use of particle repositioning maneuvers / CRP: documentation of posterior semicircular canal BPPV or other identified canal involvement and clinical response (treatment usually single session; additional 1–2 sessions over 2 weeks may be necessary).

Vestibular rehabilitation should be documented as performed by a licensed occupational or physical therapist: 'Vestibular rehabilitation should be performed by a licensed occupational or physical therapist.'

For Meniett/transtympanic micropressure: documentation that a tympanostomy tube has been inserted and that device is used according to physician prescription and training: 'After a standard ventilation tube is inserted into the tympanum ... After prescription and training by a physician, patients can treat themselves with the device at home.'

For posterior semicircular canal occlusion (surgical): documentation that BPPV is intractable/refractory to conventional maneuvers (e.g., 'refractory to head-shake and barbecue roll maneuver'), and documentation of symptom severity/disability and counseling regarding potential risks (hearing loss, vestibular loss).

For ENG/VNG testing: testing should be performed/used by trained physicians or clinicians in an appropriate doctor's office or health care facility: 'The VNG is intended for use only by trained physicians or clinicians in an appropriate doctor's office or health care facility.'

Key Coverage Criteria

Diagnosis and evaluation of chronic vertigo or Ménière's disease using caloric vestibular testing.
Diagnosis and evaluation of chronic vertigo or Ménière's disease using dynamic (head‑shaking) visual acuity testing.
Diagnosis and evaluation of chronic vertigo or Ménière's disease using head impulse / head thrust test.
Diagnosis and evaluation of chronic vertigo or Ménière's disease using optokinetic nystagmus testing.
Diagnosis and evaluation of chronic vertigo or Ménière's disease using spontaneous nystagmus testing.
Electronystagmography (ENG) is used to assess patients with vestibular disorders (e.g., dizziness, vertigo, or balance dysfunction). It provides objective testing of the oculomotor and vestibular systems.

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`S9476`, Vestibular rehabilitation program, non-physician provider, per diem

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

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S9476, Vestibular rehabilitation program, non-physician provider, per diem

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

`S9476`, Vestibular rehabilitation program, non-physician provider, per diem