Verify eligibility & consult BAM/MEA before requesting authorization

Verify member eligibility and benefits before rendering services using HAP's online Member Eligibility Application (MEA) and consult the Benefit Administration Manual (BAM); vendors must be contracted for the member's plan for prior authorization rules to apply. Note: Medicare Comp (Wrap) outpatient services for in-plan, in-network members no longer require authorization and pass through.

• Use MEA to confirm eligibility and benefits prior to service.
• Refer to BAM for coverage criteria and policy details.
• Ensure vendor is contracted to the member’s plan or authorization rules may not apply.

Unlisted HCPCS codes require HAP review and auth number

If a HCPCS code is not listed in this document, the item requires HAP review and an authorization number prior to service.

• Submit an authorization request to HAP for any HCPCS code absent from the list.

Prior authorization is not a guarantee of payment

Obtaining prior authorization does not guarantee payment; providers must still verify benefits and meet coverage criteria.

• Prior authorization is a coverage determination step, not a payment guarantee.

Most listed supply HCPCS codes: no prior authorization, verify per-line

Most HCPCS supply codes listed in the supply segments are marked 'Authorization Required = No' (no prior authorization required), but a small number of entries are explicitly marked 'Not Covered' or 'Yes' — verify each HCPCS line before ordering.

• Check the specific HCPCS line in the list for the code’s 'Authorization Required' status (Yes / No / Not Covered).
• Do not assume coverage; some codes within the range are Not Covered or require prior auth.

Ostomy supplies: mostly no prior auth but check per-code

Ostomy supply lines in the A4405–A4450 range predominantly indicate 'Authorization Required = No', though some entries are 'Not Covered' or have product-line exceptions; confirm the exact code row before providing supplies.

• Review the product lines column (e.g., ALL, MED, UAW) for exceptions.
• Confirm per-line status for any ostomy item before dispensing.

Ostomy supply auth indicators: majority 'No', some exceptions

Authorization indicators for specified ostomy supplies show most items as 'No' (no prior authorization required); some lines include 'Not Covered' or mixed values — always confirm the code’s authorization field.

• Do not rely on category assumptions; use the exact HCPCS line entry for the authorization flag.

A4437 / A4450 — irrigation sleeve (disposable): no prior auth

Irrigation sleeve (disposable) entries (A4437 / A4450) are listed with 'Authorization Required = No'.

• A4437 and A4450: Authorization Required = No (Product Lines = ALL).

A4436 / A4437 — ostomy skin barrier: no prior auth

Ostomy skin barrier codes A4436 and A4437 are listed with 'Authorization Required = No'.

• A4436/A4437: Authorization Required = No; Product Lines = ALL.

Enema/adhesive supplies: most no auth; A4458/A4459 Not Covered

Many enema and adhesive supplies (e.g., A4452, A4453, A4455–A4457) are shown as 'Authorization Required = No'; note that A4458 and A4459 (enema bag/manual pump systems) are marked 'Not Covered' for applicable product lines.

• A4452, A4453, A4455, A4456, A4457: Authorization Required = No.
• A4458, A4459: Authorization Required = Not Covered (Product Lines = ALL).

A4468 — exsufflation belt: auth required except for MCWRAP

Exsufflation belt (A4468) requires prior authorization for product lines 'ALL (Except MCWRAP)' (Authorization Required = Yes) but is listed as 'Authorization Required = No' for MCWRAP.

• A4468: Yes for ALL (Except MCWRAP); No for MCWRAP.

Some items Not Covered (e.g., A4550, A4554) while related supplies may need no auth

Several items in the list are explicitly marked 'Not Covered' (examples: surgical trays A4550 and disposable underpads A4554) while related supplies (e.g., electrodes A4556) may be 'Authorization Required = No' — ordering non-covered items risks denial.

• A4550 and A4554: Authorization Required = Not Covered.
• A4556: Authorization Required = No.

A4560 / A4564 — listed as Not Covered (denial risk)

Certain equipment is listed as not covered (e.g., A4560 Neuromuscular electrical stimulator and A4564 disposable pessary); providing these items risks denial of payment.

• A4560: Authorization Required = Not Covered.
• A4564: Authorization Required = Not Covered.

Authorization disclaimer: not a payment guarantee (repeat)

Reminder: prior authorization determinations do not guarantee payment — the document repeats that prior authorization is not a guarantee of payment.

• Authorization determinations must be corroborated with eligibility and BAM criteria to support payment.

Per-code authorization statuses vary — verify each HCPCS line

The HCPCS listings show many entries with 'Authorization Required = No', while other lines are 'Not Covered' or blank — always verify the specific HCPCS code row for the exact authorization status before billing or dispensing.

• Do not assume uniform status across a code range; consult the exact line entry.

A5512–A5514 — diabetic multiple density inserts: no prior auth

Diabetic multiple density inserts (A5512–A5514) are listed 'For diabetics only' with 'Authorization Required = No' and Product Lines = ALL.

• A5512–A5514: For diabetics only; Authorization Required = No; Key/Product Lines = ALL.

Collagen wound fillers (A6000/A6010): generally no auth; some not-covered exceptions

Collagen-based wound fillers and related supplies (A6000/A6010 and related entries) are generally listed with 'Authorization Required = No' (Key = ALL) though some specific A6000/A6010 items/modifications are marked 'Not Covered' in places.

• A6000/A6010: Authorization Required = No for many entries; some modifications/items flagged Not Covered — check the exact line.

A6000/A6010 — certain modifications/items Not Covered

Some entries under A6000/A6010 are explicitly marked 'Not Covered' (e.g., certain modifications or specific line items); ordering these will likely result in denial.

• Confirm the specific A6000/A6010 descriptor—modifications or ancillary items may be Not Covered.

Wound dressings and related supplies: no auth; confirm Medicaid validation

Collagen dressings, gel sheets, wound pouches, and alginate/fiber gelling dressings are listed with 'Authorization Required = No' for the cited codes; always check Michigan Medicaid fee schedule and Michigan Medicaid Provider Manual to validate coverage.

• A6021, A6022, A6023, A6024, A6154, A6196–A6197: Authorization Required = No.
• Validate against Medicaid resources for state-specific coverage.

Foam dressings, contact layers, gauze: mostly no auth; some impregnated gauze Not Covered

Foam dressings, contact layers, gauze and related pads (A6206–A6215, A6216–A6223, etc.) are largely listed with 'Authorization Required = No'; note that certain impregnated gauze codes (A6224–A6228, A6229) are marked 'Not Covered'.

• Most foam/contact/gauze codes: Authorization Required = No.
• A6224–A6228 and A6229: Authorization Required = Not Covered.

Wound care/gauze supplies: check per-code auth flags (mostly 'No')

Wound care and gauze supplies in the listed ranges show Authorization Required fields that are predominantly 'No', with some codes explicitly 'Not Covered'—verify each code before ordering.

• Check the exact HCPCS line; adjacent codes may differ in coverage status.

Compression garments (A65xx): generally no prior auth; watch A6512 exception

Compression garments and gradient compression stocking codes (A6501–A6533 and adjacent A65xx entries) are mostly 'Authorization Required = No'; A6512 includes a 'Yes' for a specific item in one pair—confirm the precise code row.

• Most A65xx entries: Authorization Required = No.
• A6512: shows 'Yes' for a particular item variant—review that entry specifically.

Per-A-code authorization statuses (A-codes): verify individual code lines

The document lists many HCPCS A-codes with explicit 'Authorization Required' fields—predominantly 'No' but with a number of 'Not Covered' flags; confirm each A-code's line entry before ordering or billing.

• Do not assume uniform status across enumerated ranges; consult the entry for the exact code.

A7008–A9270: mixed auth statuses; check per-code

The A7008–A9270 segment contains a mix of 'No', 'Not Covered', and some 'Yes' entries—prior authorization is repeatedly noted as not guaranteeing payment; verify each HCPCS code’s authorization status in this segment.

• Check product-line applicability where indicated (e.g., MED, UAW, MCWRAP).

Multiple entries (e.g., A8006) repeatedly listed as Not Covered — high denial risk

Several items in the A8004–A9270 range (e.g., powered grip assist glove A8006) are repeatedly marked 'Not Covered', representing a high denial risk if billed.

• A8006 and related entries: Authorization Required = Not Covered (NON-COVERED ITEM OR SERVICE).
• Avoid providing/billing items that are explicitly Not Covered without prior confirmation.

Check per-line prior authorization indicators (Yes / No / Not Covered)

Providers must review each code row to determine whether prior authorization is required; the list contains many 'Not Covered' entries, some 'Yes' (prior auth required), and many 'No' (no prior auth).

• Use the specific HCPCS line entry to determine required action before furnishing items.

Validate coverage with Michigan Medicaid fee schedule & Provider Manual

Always validate coverage against the Michigan Medicaid fee schedule and the Michigan Medicaid Provider Manual for state-specific determinations and future effective dates.

• Consult Medicaid resources when servicing Medicaid members or when product-line notes reference Medicaid validation.

Enteral/parenteral line items: authorization varies by HCPCS and product line

The list shows prior authorization requirements by line item for enteral formulas, pediatric formulas and parenteral nutrition supplies — specific items vary by product line and code; verify the HCPCS entry for the exact 'Authorization Required' value.

• Enteral/parenteral examples (B41xx–B41xx): Authorization Required varies by item and product line—check each code.

Parenteral nutrition examples (B4xxx): check per-code auth and product-line exceptions

Examples for parenteral nutrition and related supplies (e.g., B4178, B4180, B4185, B4187) include explicit 'Authorization Required' flags (some Yes, some No) and product-line exceptions (e.g., MCWRAP); check the code row before dispensing.

• B4187 (Omegaven): Authorization Required = Yes for ALL (Except MCWRAP); No for MCWRAP.

Mobility and general DME: mostly no auth, some Not Covered entries — verify per-code

Many general mobility and DME items (e.g., canes E0100, walkers E0130) are listed as 'Authorization Required = No' while select codes are 'Not Covered'—confirm the code’s authorization/coverage status before ordering.

• E0100: Authorization Required = No; other mobility codes may vary.

Authorization caveat repeated: authorization ≠ payment guarantee; document eligibility/necessity

The document repeatedly states that prior authorization is not a guarantee of payment alongside listed HCPCS code statuses — providers should document eligibility, medical necessity and adhere to BAM criteria to support claims.

• Maintain documentation of benefit verification and medical necessity even when prior authorization is obtained.

E0490/E0491 require auth except for MCWRAP; E0492/E0493 Not Covered

Power/control and oral neuromuscular electrode device codes (E0490, E0491) require prior authorization for 'ALL (Except MCWRAP)' product lines (Authorization Required = Yes) and are listed as 'No' for MCWRAP; E0492 and E0493 are listed as Not Covered.

• E0490/E0491: Yes for ALL (Except MCWRAP); No for MCWRAP.
• E0492/E0493: Authorization Required = Not Covered (Product Lines = ALL).

Nebulizer/humidifier/IPPB codes: mostly no auth; some Not Covered

Nebulizer/humidifier/IPPB-related codes show mixed authorization: many entries are 'Authorization Required = No' but certain items (e.g., E0575, some E0555/E0530 entries) are 'Not Covered' — verify the specific HCPCS line.

• E0570/E0572/E0574: Authorization Required = No.
• E0575: Authorization Required = Not Covered.

Monitors/pumps/breast pumps: check per-code auth and product-line keys

Monitors, pumps and breast pumps (E0603–E0617 range) include explicit authorization flags—many codes are 'No', some 'Yes' for specific keys (e.g., E0616 = Yes with TPC key), and some 'Not Covered' entries exist; confirm the product-line and key.

• E0603/E0604 (hospital-grade breast pumps): Authorization Required = No.
• E0616: Authorization Required = Yes (Key = TPC); product-line exceptions apply.

Lift/standing/frame/pneumatic appliance codes: mostly no auth; some Yes variants

Lift, standing frame and pneumatic appliance codes (E0628–E0670 ranges) mostly indicate 'Authorization Required = No', though some specific items or combinations show 'Yes' or product-line exceptions; verify the HCPCS line before provision.

• E0635/E0636/E0637: combinations may be Yes/No depending on variant and product line.
• Most pneumatic appliance codes: Authorization Required = No.