DME Services that require Prior Authorization List
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A provider-facing list of durable medical equipment (DME) HCPCS codes and authorization requirements used to determine when prior authorization is required for Health Alliance Plan (HAP) members; applies to providers and contracted vendors and varies by product line.
Always check Medicaid fee schedule and Michigan Medicaid Provider Manual to validate coverage.
Always check Medicaid fee schedule and Michigan Medicaid Provider Manual to validate coverage.
Document revision date noted as 11/01/2025.
Per-code Coverage & Authorization Rules
Per-code Coverage & Authorization Rules
Per-HCPCS code authorization and coverage flags for DME supplies and equipment. Entries consolidate product-line specific authorization statuses shown in the source. "Authorization" values are presented as stated (Yes / No / Not Covered) and may vary by product line.
ALL of the following
- A4206 — SYRINGE WITH NEEDLE, STERILE, 1 CC; Authorization = No; Product Lines = ALL.
- A4207 — SYRINGE WITH NEEDLE, STERILE 2CC; Authorization = Not Covered; Product Lines = ALL.
- A4208 — SYRINGE WITH NEEDLE, STERILE 3CC; Authorization = Not Covered; Product Lines = ALL.
- A4209 — SYRINGE WITH NEEDLE, STERILE 5CC; Authorization = Not Covered; Product Lines = ALL.
- A4210 — NEEDLE-FREE INJECTION DEVICE, EACH; Authorization = No for ALL (Except MED); Not Covered for MED; Key = *.
- A4211 — SUPPLIES FOR SELF-ADMINISTERED INJ.; Authorization = Not Covered; Product Lines = ALL.
- A4223 — (listed supplies) Authorization = Not Covered; Product Lines = ALL.
- A4314–A4316 — INSERTION TRAY WITH DRAINAGE BAG; Authorization = No; Product Lines = ALL.
- A4320 — IRRIGATION TRAY WITH BULB OR PISTON; Authorization = No; Product Lines = ALL.
- A4321–A4322 — THERAPEUTIC AGENT FOR URINARY CA IRRIGATION SYRINGE, BULB OR PISTON; Authorization = Not Covered; Product Lines = ALL.
- A4358–A4364 — OSTOMY FACEPLATE / SKIN BARRIER / OSTOMY CLAMP / ADHESIVE items; Authorization = No / Not Covered as noted; Product Lines = ALL.
- A4618–A4627 — Breathing circuits, face tent, tracheostomy supplies; Authorization = No for most listed codes; Product Lines = ALL.
- A6021–A6025 — COLLAGEN DRESSING / WOUND FILLER / GEL SHEET items; Authorization = No for listed codes; Product Lines = ALL.
- A6258–A6266 — WOUND CLEANSERS / WOUND FILLERS / GAUZE IMPREGNATED items; Authorization = No or Not Covered as noted; Product Lines = ALL.
- A6454–A6505 — SELF-ADHERENT BANDAGES, TUBULAR DRESSING, COMPRESSION BURN GARMENTS; Authorization = No for most codes; A6512 Authorization = Yes; Product Lines = ALL unless otherwise stated.
- A7007–A7010 — LARGE VOLUME NEBULIZER and related reservoirs/tubing: Authorization = No or Not Covered depending on code and product line; Product Lines include MED, UAW, ALL with exceptions noted.
- B4034–B4088 — ENTERAL FEEDING SUPPLY KITS, NASOGASTRIC / GASTROSTOMY TUBES: Authorization = No or Not Covered as listed; Product Lines = ALL.
- B4100–B4104 — FOOD THICKENER / ENTERAL FORMULA / ADDITIVES: Authorization = Not Covered; Product Lines = ALL.
- E0156–E0170 — Walker attachments, sitz bath, commode chairs and related accessories: Authorization = No or Not Covered as indicated; Product Lines = ALL (some MED, UAW exceptions).
- E0231–E0242 — Paraffin bath units, warming cards, bath/shower chairs, bathtub rails: Authorization = Not Covered for many codes; Product Lines = ALL (some MED/UAW distinctions).
- E0352–E0433 — Pressure-relief devices, oxygen systems: many entries Authorization = Not Covered or No; selected powered/nonpowered pressure-relief devices Authorization = Yes; oxygen systems Authorization = No or Not Covered; Product Lines = ALL.
- E0572–E0585 — Nebulizers and related aerosol equipment: Authorization = No or Not Covered for many listed codes; Product Lines = ALL.
- E0711–E0734 — TENS and related stimulatory devices: Authorization = mix of Not Covered, No, and Yes depending on code and product line; several TENS codes listed as Not Covered or No.
- E0735–E0743 — Vagus nerve stimulators, tibial nerve stimulators, rehabilitation systems, incontinence treatment systems: Authorization varies — some codes Yes for MED/UAW product lines and No/Not Covered for others; rehabilitation systems E0738/E0739 Authorization = Yes for MED, UAW (and Not Covered otherwise).
- E0755–E0770 — Osteogenesis stimulators, functional neuromuscular stimulators, electrical stimulation devices: Authorization status varies by code and product line; several codes Authorization = Yes for ALL (Except MCWRAP) and No for MCWRAP; others Not Covered.
- E0776–E0781 — IV pole, ambulatory infusion pumps: Authorization = No or Not Covered depending on specific code and product line; Product Lines include MED and ALL distinctions.
- E0940–E0955 — Traction devices, cervical harness, pelvic belts, fracture frames, wheelchair accessories: Authorization = No or Not Covered for many codes; Product Lines = ALL.
- E0956–E0990 — Wheelchair accessories (trays, toe loops, foot boxes, headrests, lateral supports), manual wheelchair accessories: Authorization = No for most codes; select accessories Not Covered; Product Lines = ALL (some MED/UAW exceptions).
- E0980–E0986 — Safety vests, seat lift mechanisms, wheelchair seat lift motors: Authorization = Not Covered or No for listed codes; Product Lines = ALL with some exceptions for MED/UAW.
- E1236–E1300 — Pediatric wheelchairs, power wheelchairs, lightweight wheelchairs, heavy duty wheelchairs, whirlpool equipment: Authorization = No or Not Covered for many items; Product Lines = ALL; select pediatric wheelchair/hospital crib codes have mixed Authorization statuses as noted.
- E1803–E1808 — Static progressive and dynamic adjustable wrist extension devices: Authorization = Not Covered or No for listed codes; Product Lines = ALL.
- E2364–E2367 — Power wheelchair accessories and batteries: Authorization = Not Covered or No for listed codes; Product Lines = ALL.
HCPCS Code Tables and Notation
| A2019 | Kerecis omega3 marigen shield, per square — Authorization: Yes (most lines); No for MCWRAP |
| A2020 | AC5 advanced wound system — Authorization: Yes (most lines) |
| A6021 | COLLAGEN / wound fillers group — Authorization: No |
| A6248 | SKIN SEALANTS/PROTECTANTS — Authorization: Not Covered |
| A6250 | SPECIALTY ABSORPTIVE DRESSING — Authorization: No |
| A6258 | (example specialty item) — Authorization: Not Covered |
| A6259 | WOUND CLEANSERS, ANY TYPE — Authorization: No / Not Covered (mixed) |
| A6260 | WOUND FILLER, GEL/PASTE, PER FL — Authorization: No / Not Covered (mixed) |
| A6261 | WOUND FILLER, DRY FORM, PER GR — Authorization: No |
| A6262 | GAUZE, IMPREGNATED, OTHER THAN W — Authorization: No |
| A4314 | INSERTION TRAY WITH DRAINAGE BAG — Authorization: No |
| A4315 | INSERTION TRAY WITH DRAINAGE BAG — Authorization: No |
| A4316 | INSERTION TRAY WITH DRAINAGE BAG — Authorization: No |
| A4320 | IRRIGATION TRAY WITH BULB OR PISTON — Authorization: No |
| A4321 | THERAPEUTIC AGENT FOR URINARY IRRIGATION SYRINGE, BULB OR PISTON — Authorization: Not Covered |
| A4326 | IRRIGATION SYRINGE, BULB OR PISTON — Authorization: (mixed) |
| A4418 | OSTOMY POUCH, CLOSED — Authorization: No |
| A4419 | OSTOMY POUCH, CLOSED — Authorization: No |
| A4420 | OSTOMY SUPPLY; MISCELLANEOUS — Authorization: No / Yes (mixed) |
| A4421 | OSTOMY SUPPLY; MISCELLANEOUS / ABSORBENT MATERIAL (SHEET) — Authorization: Not Covered / Yes (mixed) |
| A4422 | OSTOMY ABSORBENT MATERIAL (SHEET) — Authorization: No / Not Covered (by product line) |
| A4423 | OSTOMY POUCH, DRAINABLE, WITH BAR — Authorization: No |
| A4424 | OSTOMY POUCH, DRAINABLE — Authorization: No |
| A4425 | OSTOMY POUCH, DRAINABLE — Authorization: No |
| A4426 | OSTOMY POUCH, DRAINABLE — Authorization: No |
| A4618 | BREATHING CIRCUITS / FACE TENT — Authorization: No |
| A4619 | FACE TENT / TRACHEOSTOMY, INNER CANNULA — Authorization: No |
| A4620 | VARIABLE CONCENTRATION MASK / TRACHEOSTOMY, INNER CANNULA — Authorization: No |
| A4623 | TRACHEAL SUCTION CATHETER, ANY TYPE — Authorization: No |
| A4624 | TRACHEOSTOMY CARE KIT FOR NEW TR — Authorization: No |
| A4625 | TRACHEOSTOMY CLEANING BRUSH, EA — Authorization: No |
| A4626 | SPACER, BAG OR RESERVOIR — Authorization: No |
| A4628 | OROPHARYNGEAL SUCTION CATHETER — Authorization: No |
| A4629 | TRACHEOSTOMY CARE KIT FOR ESTABLISHED PATIENT — Authorization: No |
| A4630 | REPLACEMENT BATTERIES, MEDICALLY NECESSARY — Authorization: Not Covered |
| A6021 | Collagen dressing / wound filler group — Authorization: No |
| A6022 | COLLAGEN DRESSING, PAD — Authorization: No |
| A6023 | COLLAGEN DRESSING WOUND FILLER — Authorization: No |
| A6024 | GEL SHEET FOR DERMAL OR EPIDERMAL — Authorization: No |
| A6248 | SKIN SEALANTS/PROTECTANTS — Authorization: Not Covered |
| A6228 | (A6228–A6266 series represented) — see codes through A6266 range — Authorization: mixed; many No |
| A6266 | GAUZE, IMPREGNATED, OTHER THAN W — Authorization: No |
| A7007 | LARGE VOLUME NEBULIZER, DISPOSABLE — Authorization: No / Not Covered (mixed by product line) |
| A7008 | LARGE VOLUME NEBULIZER, DISPOSABLE — Authorization: Not Covered |
| A7009 | RESERVOIR BOTTLE, NON-DISPOSABLE — Authorization: Not Covered |
| A7010 | CORRUGATED TUBING, DISPOSABLE — Authorization: Not Covered / No (by product line) |
| A7012 | (A7012–A7049 series represented) — Authorization: mixed |
| A9270 | NON-COVERED ITEM OR SERVICE — Authorization: Not Covered |
| A9272 | MECHANICAL WOUND SUCTION — Authorization: Not Covered |
| A9273 | HOT WATER BOTTLE, ICE CAP OR COLLAR — Authorization: Not Covered |
| A9275 | SENSOR; INVASIVE (e.g., subcutaneous) — Authorization: Yes (A9275–A9278 group flagged Yes) |
| A9900 | MISCELLANEOUS DME SUPPLY, ACCESS. — Authorization: Not Covered |
| A9999 | MISCELLANEOUS DME SUPPLY OR ACCESSORY — Authorization: Yes |
| B4034 | ENTERAL FEEDING SUPPLY KIT; SYRINGE — Authorization: No |
| B4035 | ENTERAL FEEDING SUPPLY KIT; PUMP — Authorization: No |
| B4036 | ENTERAL FEEDING SUPPLY KIT; GRAVITY — Authorization: No |
| B4081 | NASOGASTRIC TUBING WITH STYLET — Authorization: No |
| B4082 | NASOGASTRIC TUBING WITHOUT STYLET — Authorization: No |
| B4087 | GASTROSTOMY/JEJUNOSTOMY TUBE — Authorization: No |
| B4100 | FOOD THICKENER, ORAL — Authorization: Not Covered |
| B4102 | ENTERAL FORMULA, ADULT — Authorization: Not Covered |
| B4152 | ENTERAL FORMULAE; CATEGORY II: INT — Authorization: Yes (selected lines) |
| B4187 | Omegaven, 10 grams lipids — Authorization: Yes (mixed) |
| E0156 | SEAT ATTACHMENT, WALKER — Authorization: Not Covered (MED, UAW) |
| E0291 | HOSPITAL BED, VARIABLE HEIGHT, HI-LO — Authorization: No |
| E0296 | HOSPITAL BED, TOTAL ELECTRIC — Authorization: Not Covered |
| E0300 | PEDIATRIC CRIB, HOSPITAL GRADE — Authorization: Yes (in MED) / Not Covered (others) |
| E0371 | NONPOWERED ADVANCED PRESSURE REDUCTION SURFACE — Authorization: Yes |
| E0372 | POWERED AIR OVERLAY FOR MATTRESS — Authorization: Yes |
| E0373 | NONPOWERED ADVANCED PRESSURE REDUCTION SURFACE — Authorization: Yes |
| E0424 | STATIONARY COMPRESSED GASEOUS OXYGEN SYSTEM — Authorization: No |
| E0425 | STATIONARY COMPRESSED GAS SYSTEM / PORTABLE GASEOUS OXYGEN — Authorization: Not Covered |
| E0486 | ORAL DEVICE/APPLIANCE USED TO REDUCE SNORING — Authorization: No |
| E0980 | SAFETY VEST, WHEELCHAIR — Authorization: Not Covered |
| E0983 | WHEELCHAIR ACCESSORY, BACK UPHOLSTERY — Authorization: Not Covered |
| E0985 | WHEELCHAIR ACCESSORY, SEAT LIFT — Authorization: No/Not Covered (mixed) |
| E1233 | WHEELCHAIR, PEDIATRIC SIZE, TILT-IN — Authorization: No |
| E1239 | POWER WHEELCHAIR, PEDIATRIC SIZE — Authorization: Not Covered (selected) |
| E1240 | LIGHTWEIGHT WHEELCHAIR, DETACHABLE — Authorization: Not Covered |
| E1233 | WHEELCHAIR, PEDIATRIC SIZE, TILT-IN — Authorization: No |
| E1234 | WHEELCHAIR, PEDIATRIC SIZE, TILT-IN — Authorization: No |
| E1235 | WHEELCHAIR, PEDIATRIC SIZE, RIGID — Authorization: No |
| E1236 | WHEELCHAIR, PEDIATRIC SIZE, FOLDING — Authorization: No |
| E1285 | HEAVY DUTY WHEELCHAIR, FIXED FULL — Authorization: Not Covered |
| E1290 | HEAVY DUTY WHEELCHAIR, DETACHABLE — Authorization: Not Covered |
| E1295 | HEAVY DUTY WHEELCHAIR, FIXED FULL — Authorization: Not Covered |
| E1296 | SPECIAL WHEELCHAIR SEAT HEIGHT — Authorization: Not Covered |
| E1297 | SPECIAL WHEELCHAIR SEAT DEPTH — Authorization: Not Covered |
| E1298 | SPECIAL WHEELCHAIR SEAT DEPTH AND WIDTH — Authorization: Not Covered |
Verification, Authorization & Billing Advisories
Verify vendor contract status and member benefits (MEA/BAM)
Vendors must be contracted for the member's plan in order for the Services that require Prior Authorization rules to apply; providers must verify benefit coverage via HAP's online Member Eligibility Application (MEA) and the Benefit Administration Manual (BAM) prior to rendering service.
- Failure to verify benefits may result in denial of payment and members must be held harmless.
Medicare Comp (Wrap) outpatient authorization exception
Medicare Comp (Wrap) Members for outpatient services do not require authorization if the Member is in-plan and in-network.
Prior authorization is not a guarantee of payment
A prior authorization determination does not guarantee payment; providers should not assume authorization ensures reimbursement.
Check per-code authorization for A43xx ostomy/urinary supplies
Authorization status for A43xx urinary/ostomy supply codes is specified per code; many entries in this group are listed as 'Authorization = No' while some are 'Not Covered'.
- Examples: A4314–A4320 entries show Authorization = No; A4321–A4322 show Authorization = Not Covered.
Ostomy items marked Not Covered — do not expect payment
Multiple ostomy-related items are explicitly labeled 'Not Covered' in the listing; submitters should not bill expecting coverage for those codes.
- Examples: A4360–A4363 are marked Authorization = Not Covered.
Mixed authorization examples for ostomy/absorbent products — verify per item
Some ostomy and absorbent product entries demonstrate mixed authorization outcomes (No / Yes / Not Covered); providers must confirm the specific authorization status for the member and product line.
- Example: A4420–A4422 show mixed Authorization = No / Yes / Not Covered depending on the line item and product line.
Verify authorization status per HCPCS A-codes
The document lists authorization statuses per HCPCS code (Yes / No / Not Covered) for selected A-codes; verify each code's Authorization value before submitting a prior authorization request or claim.
- Entries include examples of Authorization = No, Authorization = Yes, and Authorization = Not Covered for listed A-codes.
Confirm authorization-required codes (examples: A4468, A4540)
Certain specific A-codes are shown with Authorization = Yes for select product lines; confirm authorization requirements for these codes before ordering.
Do not bill for codes explicitly marked Not Covered (e.g., A4458, A4459)
Some items are explicitly marked 'Not Covered' in the A-code listings; do not submit these expecting coverage without prior HAP determination.
Review listed A46xxx HCPCS codes for per-code authorization
The A46xxx range includes many HCPCS entries with Authorization = No and some marked Not Covered; prior authorization may not be required for many items but payment is not guaranteed.
- Providers should confirm product-line applicability and authorization values for each A46xxx code prior to service.
Validate coverage against Medicaid fee schedule and Michigan Medicaid Provider Manual
Always check the Medicaid fee schedule and the Michigan Medicaid Provider Manual to validate coverage and applicability for Medicaid-related product lines.
- The document repeatedly advises providers to validate coverage with state Medicaid resources.
Collagen dressings (A6021–A6025) listed Authorization = No — confirm payment expectations
Multiple collagen dressing and gel sheet supply codes (A6021–A6025 and related entries) are listed with Authorization = No for Product Lines = ALL; providers should note that 'Authorization = No' does not guarantee payment.
- Examples: A6021–A6025 show Authorization = No and Product Lines = ALL.
Alginate/composite/contact/foam dressings — Authorization = No (verify per code)
Alginate, composite, contact-layer and foam wound dressings are listed with Authorization = No for Product Lines = ALL; verify per-code status before ordering.
- Examples include A6154, A6196–A6204 which are shown with Authorization = No.
Specialty absorptive dressings and skin sealants — verify coverage
Specialty absorptive dressings and skin sealants include items marked Not Covered or Authorization = No; always verify code-level and product-line applicability and consult Medicaid resources if applicable.
Verify authorization statuses for listed A-codes and product lines
Providers must check the authorization status for listed HCPCS A-codes; many codes show Authorization = No while select codes are marked Authorization = Yes or Not Covered, and prior authorization does not guarantee payment.
- Confirm per-code authorization and product-line applicability before ordering or billing.
Authorization disclaimer: authorization ≠ payment guarantee
Operational reminder: prior authorization is not a guarantee of payment — authorization decisions do not ensure reimbursement.
Document revision date noted
Document revision note recorded in this segment: Revised: 11/01/2025.
Confirm per-code authorization outcomes for DME/supplies
The DME/supplies segments list HCPCS codes with explicit Authorization statuses (Yes / No / Not Covered) and product-line scope; confirm the listed Authorization value and the Product Lines field for each code prior to service.
Walker/commode attachments (E0156–E0162) — verify coverage/authorization
Many walker and commode attachment codes (E0156–E0162 range) are listed as Authorization = No or Authorization = Not Covered; verify the code before dispensing.
- Example: E0156 is marked Authorization = Not Covered for some product lines.
Commode seat lift mechanisms marked Not Covered
Certain commode seat lift mechanisms and related items are identified as Not Covered in the listing; do not expect coverage for these items unless otherwise specified.
- Examples: E0171–E0175 seat lift mechanisms are marked Not Covered.
Pressure-relief mattresses/pads and flotation beds — many No/Not Covered; some powered items Yes
Pressure-relief mattresses, pads and flotation bed entries (E0181–E0191 series) are predominantly Authorization = No or Not Covered; some powered pressure-reducing mattresses are authorized (Yes) — confirm per code.
- Examples: E0181–E0187 entries show Authorization = No; select powered items may be Yes.
Heating and therapeutic light equipment — many items Not Covered or No
Heat lamps, therapeutic lightboxes and heating pads (E0202–E0221 range) are largely Not Covered or Authorization = No with product-line exceptions; verify the specific code and product line.
Bath and toilet assistive devices marked Not Covered
Bath, shower and toilet assistive devices (E0240–E0248) and transfer/rail devices are listed as Not Covered for all product lines in this segment.
Hospital beds and pressure-reducing surfaces — mixed authorization outcomes
Hospital beds and pressure-reducing surfaces (E0250–E0277) show mixed statuses — many Authorization = No, some Not Covered, while specific powered pressure-reducing air mattresses and bed cradles are marked Authorization = Yes.
- Example: E0277 (powered pressure-reducing air mattress) is Authorization = Yes; many bed codes are No or Not Covered.
Later hospital/pediatric bed items — check per-code authorization and product-line exceptions
Later hospital and pediatric bed items (E0277–E0302 range) include authorized powered pressure-reducing mattresses and select pediatric beds alongside many Not Covered entries; verify product-line exceptions (e.g., MED).
- Examples: certain pediatric cribs and powered mattresses show Authorization = Yes while others are Not Covered.
Hospital beds (variable height/semi/total electric) — many No/Not Covered
Hospital bed E-codes for variable height, semi-electric and total electric beds are recorded as Authorization = No or Not Covered for many entries; remember that prior authorization does not guarantee payment.
- Examples: E0291–E0296 show multiple No or Not Covered statuses.
Respiratory/oxygen equipment — mixed authorization statuses
Respiratory and oxygen equipment E-codes have mixed authorization results — some codes show Yes, but many are No or Not Covered; confirm each code and product line prior to ordering.
Ventilators and respiratory assist devices — verify per-code/product-line authorization
Ventilators and respiratory assist devices show variable authorization (mostly No, some Yes tied to product line like MCWRAP); verify the code's Authorization value for the member's product line.
Airway clearance, spirometry, humidifier and nebulizer equipment — verify coverage
Airway clearance, spirometry, humidifier and nebulizer equipment are largely marked No or Not Covered with some product-line exceptions; check each code before prescribing or billing.
- Examples: E0486–E0487 = No; many nebulizer codes (E0562–E0575) listed as No or Not Covered.
Nebulizers and compressors — commonly No or Not Covered
Many nebulizer and compressor HCPCS codes are listed with Authorization = No or Not Covered for all product lines; do not assume prior authorization guarantees payment.
Selected equipment with mixed authorization — check product-line details
Selected equipment entries show mixed authorization by product line (examples: E0605 vaporizer Not Covered for most lines but No for MED/UAW; E0616 implantable cardiac event record Authorization = Yes with key TPC for specified lines).
- Confirm the Product Lines field for codes with mixed statuses.
Compression device authorization varies by product line
Intermittent limb compression devices and non‑pneumatic sequential compression garments have variable authorization: some codes are Authorization = Yes for selected product lines, while others are Not Covered.
Electrical stimulation device authorization — many Not Covered; select items may require authorization
Many electrical stimulation/TENS-related codes are listed as Not Covered or Authorization = No; select stimulation devices (e.g., E0731, E0734, E0735) show Authorization = Yes for non‑MCWRAP lines.
Mixed authorization by product line — confirm product-line applicability
Authorization outcomes vary by product line for multiple codes; some codes are Authorization = Yes for certain lines (often ALL except MCWRAP) while the same codes may be No or Not Covered for other lines—verify product-line applicability.
Provider advisory — verify Medicaid resources; authorization ≠ payment
Reminder to providers: prior authorization is not a guarantee of payment; always check the Medicaid fee schedule and Michigan Medicaid Provider Manual to validate coverage.
Authorization outcomes for wheelchair/accessory HCPCS codes — most No/Not Covered; some accessories Yes
Wheelchair and accessory HCPCS codes show many entries as Authorization = Not Covered or Authorization = No; specific accessories may be authorized for select product lines—check each code's status.
Medicaid validation advisory — check fee schedule and provider manual
Advises providers to check the Medicaid fee schedule and Michigan Medicaid Provider Manual to validate coverage for state Medicaid-related product lines.
Prior authorization and coverage indicators for listed HCPCS E-codes
The table lists HCPCS E-codes with explicit Authorization statuses (Yes / No / Not Covered); providers must confirm the code-level Authorization entry before submitting requests or claims.
- The listing includes many E-code examples with per-line Authorization values.
Wrist orthotic devices (E1803–E1808) — Not Covered/No
Wrist orthotic devices (E1803–E1808) are recorded as Authorization = Not Covered or Authorization = No in the listing; verify the specific code and product line prior to ordering.
- Examples: E1803–E1805 show No / Not Covered statuses.
Lower/upper extremity orthoses and supplies — verify per-code authorization
Lower and upper extremity dynamic/static orthoses and replacement soft interface materials frequently show Authorization = No or Authorization = Not Covered; confirm code-level status.
Misc DME and manual wheelchair accessories — mixed authorization; check per code
Miscellaneous DME and manual wheelchair accessories (communication boards, suction pumps, monitors, etc.) have mixed Authorization statuses (mostly No/Not Covered; some Yes for specific product lines); confirm each code and product-line mapping.
Power wheelchair accessories and seating — many No/Not Covered; selected accessories authorized
Power wheelchair accessories and pediatric seating/back items show many codes as Authorization = No or Not Covered; select accessories (e.g., E2298, E2327, E2328, grouped E2329/E2330) may show Authorization = Yes for specific product lines.
Key Terms & Abbreviations
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