Verify eligibility and obtain prior authorization via MEA and BAM

Providers must verify member eligibility and benefit coverage using HAP's online Member Eligibility Application (MEA) and the Benefit Administration Manual (BAM) prior to rendering services; vendors must be contracted for the member's plan for the prior authorization rules to apply.

• Verify eligibility and benefits via HAP MEA before providing services.
• Consult the BAM for coverage criteria and rules.
• Ensure vendor is contracted for the member's plan so prior authorization rules apply.

Medicare Comp (Wrap) outpatient authorization exception

Medicare Comp (Wrap) members receiving outpatient services that are in-plan and in-network do not require prior authorization (these services pass through without authorization).

• Applies only when the member is IN PLAN and In Network.

Prior authorization does not guarantee payment — verify benefits

A prior authorization determination is explicitly not a guarantee of payment; providers must still verify benefit coverage to avoid claim denials and must hold Members harmless if coverage was not verified.

• Prior authorization does not assure payment — check member benefits and subscriber documents.
• Failure to verify benefits prior to service may result in payment denial; Members must be held harmless.

Example HCPCS A4340–A4542: per-code authorization statuses

The policy lists HCPCS codes in the A4340–A4542 range with authorization statuses (e.g., Authorization = No, Yes, or Not Covered) and product-line qualifiers; providers should consult the listing for each specific code.

• Example codes and dispositions are shown in the A4340–A4542 range (Authorization = No for many entries).
• Some codes include product-line-specific variations—verify per-code status.

Validate coverage using Michigan Medicaid fee schedule and Provider Manual

Always validate coverage and payment rules against the Michigan Medicaid fee schedule and the Michigan Medicaid Provider Manual as noted in the listing.

• Use Michigan Medicaid fee schedule and Provider Manual to confirm state-specific coverage and exceptions.

Authorization is not a guarantee of payment (reminder)

The document reiterates that prior authorization is not a guarantee of payment; an approved authorization does not replace verification of benefits for payment assurance.

• Providers should not assume authorization equates to payment—confirm benefit eligibility and coverage.

HCPCS A44xx–A55xx: per-code authorization flags and product-line notes

HCPCS-level entries in the A44xx–A55xx ranges are documented with Authorization = Yes / No / Not Covered and applicable Product Lines (commonly ALL); specific per-code examples and product-line exceptions are listed for provider reference.

• Examples include A4468 (Exsufflation belt) showing Authorization = Yes for ALL except MCWRAP where Authorization = No, and A4540 showing similar product-line variation.

Medicaid fee schedule/Provider Manual validation required

Always check the Michigan Medicaid fee schedule and Provider Manual to validate coverage for individual HCPCS codes as the listing may include product-line exceptions.

• Do not rely solely on the HCPCS list—confirm state Medicaid coverage details where applicable.

Authorization disclaimer — not a payment guarantee

The policy repeats that prior authorization is not a guarantee of payment; providers must continue to verify benefits and coverage applicability for each claim.

• An authorization determination does not ensure payment — verify benefits and member documents.

A55xx–A65xx example: many No/Not Covered, some Yes (e.g., A6511/A6512)

Many A55xx–A65xx range codes are marked Authorization = No or Not Covered, though a few codes (e.g., A6511, A6512) are authorized; providers should reference the per-code entries to determine authorization requirements.

• Example: A6511 and A6512 are listed with Authorization = Yes.
• Multiple other codes in the range are marked No or Not Covered—check the list for each code.

Authorization disclaimer — verify coverage for payment

Prior authorization is not a guarantee of payment; providers must verify benefits even when an authorization is obtained.

• Confirm member coverage and payment rules in addition to obtaining authorization.

Example Not Covered codes: A6590 and A6591

The policy lists A6590 and A6591 (external urinary catheters) as Authorization = Not Covered; providers should not seek authorization for items explicitly marked Not Covered and must follow coverage exclusions.

• A6590: External urinary catheters — Authorization = Not Covered.
• A6591: External urinary catheter, non-disposable — Authorization = Not Covered.

Examples of HCPCS that require authorization (A6511, A6512)

Certain items (e.g., A6511, A6512 compression burn garment codes) are shown with Authorization = Yes — providers must obtain prior authorization for those specific HCPCS entries.

• A6511 and A6512: Authorization = Yes (compression burn garments).

HCPCS supply/equipment authorization listings (partial)

The policy contains HCPCS authorization status listings for supplies and equipment showing Authorization = No / Not Covered / Yes; providers should consult the per-code entries and not assume uniform status across codes.

• Per-code authorization fields indicate Yes/No/Not Covered and may vary by product line.

Validate product-line exceptions via Michigan Medicaid resources

Providers must check the Michigan Medicaid fee schedule and Michigan Medicaid Provider Manual to validate coverage and review product-line-specific authorizations (e.g., McWRAP, MED) shown in the code listing.

• Some codes have different authorizations by product line—confirm with Medicaid resources as advised.

Authorization disclaimer — not payment assurance

The listing repeats that prior authorization is not a guarantee of payment and must be interpreted alongside benefit verification and coverage rules.

• Do not equate authorization with payment — confirm benefits.

Reminder: validate against Michigan Medicaid fee schedule and Provider Manual

The policy reminds providers to check the Michigan Medicaid fee schedule and Provider Manual to validate coverage applicability and payment rules for HCPCS items.

• Where state Medicaid coverage may affect authorization, consult the fee schedule and Provider Manual.

General HCPCS authorization notice and example code statuses

The document provides a general authorization notice and lists multiple HCPCS codes (e.g., E0231, E0235, E0239, E0240) with Authorization statuses including 'Not Covered' and 'No'; providers should review per-code entries for specific authorization outcomes.

• Example: E0231 is Authorization = Not Covered; E0235 varies by product line.

Medicaid validation advisory — confirm state-specific coverage

Always check the Michigan Medicaid fee schedule and Provider Manual to validate coverage and state-specific exceptions when using this HCPCS listing.

• State Medicaid resources are the authoritative reference for coverage validation.

Examples of HCPCS explicitly authorized (e.g., powered pressure-reducing air mattress)

Some HCPCS entries are explicitly authorized (e.g., powered pressure-reducing air mattress E0277/E0280/E0290 marked 'Yes'); obtain prior authorization for codes listed as 'Yes'.

• E0277/E0280/E0290: Authorization = Yes for the powered pressure-reducing air mattress group.
• Obtain authorization per the listing for these entries.

Authorization summary for E0560–E0840 range (mixed statuses)

The E0560–E0840 fragment contains mixed Authorization statuses (No, Not Covered, Yes) across many entries; providers must check the specific code entry to determine whether prior authorization is required.

• Entries in this range include humidifiers, nebulizers, and neurostimulation devices with varying authorization outcomes.

Confirm coverage with Michigan Medicaid fee schedule/Provider Manual

Always confirm coverage applicability using the Michigan Medicaid fee schedule and Provider Manual when interpreting per-code authorization entries.

• The listing repeatedly directs providers to verify with Medicaid resources.

Partial HCPCS entries with explicit Yes/No/Not Covered and product-line notes

Partial HCPCS authorization entries (e.g., E0770, E0776, E0779, E0780) show explicit Authorization = Yes/No/Not Covered and product-line applicability; review each code's line to determine authorization requirements.

• E0770: Authorization = No for MCWRAP (example of product-line variation).
• E0779: Authorization = Not Covered (varies by product line).

Wheelchair accessory codes — many require authorization

Wheelchair accessory codes include many marked 'Authorization = Yes' and others 'No' or 'Not Covered'; where authorized, obtain prior authorization as shown in the listing.

• Examples: E1004–E1009 and E1012 show several 'Yes' authorizations for wheelchair accessories.
• Check the listing for per-code authorization and product-line applicability.

E-code authorization outcomes — verify per code

The policy lists authorization outcomes for numerous E-series codes (e.g., E1092/E1093 marked Not Covered; others marked Yes or No); verify each code prior to ordering or billing.

• E1092 and E1093: Authorization = Not Covered (wide heavy duty wheelchairs).
• Some E-codes are authorized (Yes) while many are No or Not Covered—check per-code.

Pediatric wheelchair codes — many No or Not Covered

Several pediatric and power wheelchair codes are explicitly marked No or Not Covered (e.g., E1239 Not Covered); providers should confirm authorization status before provision.

• E1239: Power wheelchair, pediatric size — Authorization = Not Covered.
• Multiple pediatric wheelchair codes listed as Authorization = No.

Late-range equipment entries often No/Not Covered — validate with Medicaid

Later-range DME entries include many Authorization = No or Not Covered flags and remind providers to consult the Michigan Medicaid fee schedule and Provider Manual to validate coverage.

• Examples include E1800 (Authorization = No) and E1801 (Authorization = Not Covered).
• Provider must validate coverage with Medicaid resources where applicable.

Authorization disclaimer — not a payment guarantee (repeated)

The document again emphasizes that a prior authorization determination does not guarantee payment; providers must verify benefits and coverage for billing accuracy.

• Authorization ≠ payment; verify member coverage and subscriber documents.

E18xx examples with explicit No / Not Covered statuses

Examples in the E18xx series show explicit Authorization statuses (e.g., E1800 = No; E1801 = Not Covered; E1806 = Not Covered); providers must check each E18xx entry for the applicable authorization outcome.

• E1800: Authorization = No.
• E1801: Authorization = Not Covered.
• E1806: Authorization = Not Covered.

E2xxx examples: select codes authorized for specific product lines

Selected E2xxx entries (e.g., E2001 suction pump and E2103 non-adjunctive CGM) are shown with Authorization = Yes for specified product lines — obtain authorization where indicated.

• E2001: Authorization = Yes for ALL except MCWRAP (MCWRAP = No).
• E2103: Authorization = Yes for McWRAP and MED (other product lines vary).

Mixed authorization by product line (example: E2298)

Some codes have mixed authorization by product line (e.g., E2298 complex rehabilitative power wheelchair accessory: Yes for ALL except MCWRAP; No for MCWRAP); verify the code's product-line applicability before ordering.

• E2298: Authorization = Yes (Product Lines = ALL except MCWRAP); Authorization = No for MCWRAP.

Validate per-code and product-line exceptions with Medicaid resources

Always validate per-code coverage and product-line exceptions against the Michigan Medicaid fee schedule and Provider Manual as the listing frequently references state-specific rules.

• When a code shows product-line variation, confirm which product line applies to the Member and verify with Medicaid resources.

Authorization disclaimer — verify coverage for billing

The policy reiterates that prior authorization is not a guarantee of payment and providers must verify coverage for each HCPCS entry before billing.

• Confirm benefits even when an authorization is issued.

State Medicaid validation reminder (Michigan)

State Medicaid validation is reiterated: always check the Michigan Medicaid fee schedule and Michigan Medicaid Provider Manual to validate coverage and payment rules for HCPCS codes.

• The listing includes repeated prompts to consult Michigan Medicaid resources for definitive coverage decisions.

Examples of authorized wheelchair base/power wheelchair items (K-codes)

Selected wheelchair base and power wheelchair K-codes are listed with Authorization = Yes (examples include K0008, K0009, K0012, K0013, K0014); obtain prior authorization for those codes marked 'Yes'.

• K0008, K0009, K0012, K0013, K0014: Authorization = Yes for specified entries.

Examples of mixed authorization/coverage (speech devices, infusion pumps)

The list shows mixed authorization and coverage for devices such as speech generating devices and infusion pumps (examples include E2500 = No, E2506 = Yes, K0455 = Not Covered); verify each specific code prior to ordering or billing.

• E2500: Authorization = No (speech generating device example).
• E2506: Authorization = Yes (speech generating device example).
• K0455: Authorization = Not Covered (infusion pump example).

HCPCS K-code authorization entries — check per-code status

HCPCS K-codes are listed with individual Authorization = Yes/No values and apply across Product Lines = ALL unless otherwise noted; prior authorization status may affect billing and coverage.

• K0069, K0071, K0072, K0073, K0077, etc., shown with per-code Authorization values.
• Where Product Lines differ, consult the listing for product-line-specific applicability.

Power wheelchair group codes — many Yes, with MCWRAP exceptions

Power wheelchair group codes show mixed Authorizations with many marked Yes, and some variants No for MCWRAP; obtain authorization where codes are marked 'Yes' and verify product-line applicability.

• Examples: K0821–K0827 series show Authorization = Yes for many group 2 power wheelchair codes.
• MCWRAP exceptions may change authorization to No for some variants.

Power wheelchair group codes marked Not Covered / No

Multiple higher-group power wheelchair codes are explicitly marked Not Covered or Authorization = No; do not submit claims assuming coverage for those codes.

• K0871, K0877, K0878, K0879, K0880, K0884, etc., are marked Not Covered or No.

Orthosis and other equipment codes commonly No or Not Covered

Various equipment and cervical orthosis codes are listed with Authorization = No or Not Covered; providers should not assume coverage and must verify each orthosis code prior to provision.

• Examples include L0112–L0174 range and other orthosis entries marked No or Not Covered.
• L0220 is specifically marked Not Covered.