We’re correcting an issue with CPT code 0523T:
Intraprocedural coronary fractional flow reserve (FFR) with 3D functional mapping… (List separately in addition to code for primary procedure).
This code is billed as an add-on to primary procedure codes 93454–93461.
What happened?
Code 0523T was mistakenly set up in our system to require prior authorization. It’s not managed by EviCore and is not separately payable from the primary procedure for all products. Because of this, some claims denied for “no authorization.”
The issue impacts claims with dates of service on or after Dec.1, 2024.
There’s nothing you need to do. We’re currently working to correct the system error.