Prior authorization requirements for DME repair and portable oxygen concentrator
This document governs new prior authorization (PA) requirements for certain durable medical equipment (DME) repairs and portable oxygen concentrator rentals for Anthem Blue Cross and Blue Shield members, effective July 1, 2019, and affects contracted providers submitting claims for the listed HCPCS codes.
PA requirements will be added for E1392 (portable oxygen concentrator, rental) and K0739 (repair or nonroutine service for DME other than oxygen).
Prior Authorization Coverage Criteria
PA coverage criteria (summary)
PA requirements are added for the following codes; coverage decisions must also consider federal/state law and CMS guidelines:
Codes requiring PA
- E1392 — Portable oxygen concentrator, rental: Prior authorization required for rental of a portable oxygen concentrator.
See provider actions for how to request PA.
- K0739 — Repair or nonroutine service for durable medical equipment other than oxygen requiring the skill of a technician, labor component, per 15 minutes: Prior authorization required for repair or nonroutine service.per 15 minutes
See provider actions for how to request PA.
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