Does T1001 require prior authorization?

No, T1001 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for T1001?

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

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`T1001`, Left foot, second digit

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

Documentation that the child meets an eligible condition per state-defined criteria for developmental delay (medical/diagnostic documentation of developmental delay or high risk).
Individual Family Service Plan (IFSP) for any child recognized as having a disability that interferes with learning from infancy to age 3; IFSP must include specific early intervention services the family and child will receive and a projection of their duration (per Education of the Handicapped Act Amendments requirement).

When applicable, standardized developmental screening and testing results with scoring and documentation (e.g., use of standardized instruments as described by CPT/HCPCS such as 96110, 96112/96113, G0451) including interpretation and report.

Clinical records supporting the medical necessity of component services (e.g., assessments, therapy plan, progress notes, rationale for PT/OT/speech therapy or other services tied to the eligible condition).

Compliance with any state-specific documentation/eligibility requirements (states create their own definitions of developmental delay and determine eligibility for services).

Key Coverage Criteria

Early intervention programs (coordinated multidisciplinary care) for children from infancy to 3 years of age who have developmental delays or have a high potential for developmental delay.
Children with biological conditions that may predispose to a developmental delay (eligible for early intervention services).
Children at risk of developing developmental delays attributable to environmental factors (eligible for early intervention services).
Coverage of component services of early intervention programs (such as speech therapy, physical therapy, occupational therapy, psychological counseling for families, nursing care, and physical or social stimulation) when the child presents with an eligible condition.
Provision of services described in an Individual Family Service Plan (IFSP) for a child recognized as having a disability that interferes with learning from infancy to age 3 (IFSP defines specific early intervention services and projected duration).
I. Home health services are consideredmedically necessarywhenallof the followingcriteriaA through Dare met:

2 Active Policies

ANTHEM-CG-MED-23, Home Health

AETNA-CPB-0444, Early Intervention Programs

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T1001, Left foot, second digit