CPT 23474 · Procedure (templated) · Medicare (FCSO MAC)
Revision TSA — Both Components at Medicare (FCSO MAC).
How Medicare (FCSO MAC) approaches CPT 23474 (Revision TSA — Both Components) for prior-authorization review: at last review on 2026-05-02, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-02
Criteria summary
High-level themes from the Medicare (FCSO MAC) policy of record for CPT 23474. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 6 weeks of conservative care typically required.
- Imaging concordance documentation required.
See the full Medicare (FCSO MAC) criteria.
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