Does T2036 require prior authorization?

No, T2036 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for T2036?

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

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`T2036`, Therapeutic camping, overnight, waiver; each session

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

When relying on other CPBs (e.g., Acupuncture CPB 0135, Biofeedback CPB 0132, Chelation CPB 0234, Chiropractic CPB 0107, Electrical Stimulation CPB 0011), include documentation required per those CPBs (clinical notes, prior therapy trial details, objective findings) as applicable.

For services listed as excluded or experimental/investigational, include documentation if an exception is being requested (e.g., supporting literature, rationale for use outside usual practice) though the CPB states these are considered experimental/investigational and not supported.

Coverage of alternative medicine interventions is 'subject to applicable benefit plan limitations and exclusions' and requires that interventions be 'supported by adequate evidence of safety and effectiveness in the peer-reviewed published medical literature' and used for 'properly selected members' (implying clinical justification and supporting literature should be present in the medical record).

Coverage determinations in each specific instance require consideration of: 1) the terms of the applicable benefit plan document in effect on the date of service; 2) any applicable laws/regulations; 3) any relevant collateral source materials including Coverage Policies; and 4) the specific facts of the particular situation.

Key Coverage Criteria

Augmented soft tissue mobilization (ASTM) — considered proven non-preferentially for physical therapy (i.e., considered a proven physical therapy approach but no reliable evidence it is superior to other providers).
Chelation therapy - see CPB 0234 - Chelation Therapy
Chiropractic services - see CPB 0107 - Chiropractic Services
Electrical stimulation - see CPB 0011 - Electrical Stimulation for Pain
Aetna considers Airrosti (Applied Integration for the Rapid Recovery of Soft Tissue Injuries) and augmented soft tissue mobilization (ASTM) as proven non-preferentially for physical therapy (i.e., considered proven but lack of evidence of superiority to other physical therapy providers).
Aetna considers alternative medicine interventions medically necessary if they are supported by adequate evidence of safety and effectiveness in the peer-reviewed published medical literature.

2 Active Policies

AETNA-CPB-0388, Complementary and Alternative Medicine

CIGNA-EN0086, Complementary and Alternative Medicine

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T2036, Therapeutic camping, overnight, waiver; each session