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DME providers: Reminder about power wheelchair, CGM auths
May 27, 2022

This article is for durable medical equipment providers caring for our members

We’d like to remind you that effective June 1, 2022, we’ll require prior authorization for power wheelchairs and continuous glucose monitors (CGM).

Power wheelchair authorization requirements

As you may recall, we’ll require authorization for power wheelchairs for our commercial and Medicare Advantage members. We informed you in December 2021 of upcoming changes to medical policy 365: Manual and Power Operated Wheelchairs.

Please note that these prior authorization requirements only apply to the codes listed below. Other equipment listed in the medical policy, such as accessories and manual wheelchairs, don’t require prior authorization.

Power wheelchair HCPCS codes requiring prior authorization

When submitting requests for prior authorization, only submit the appropriate power wheelchair code along with supporting clinical documentation.

K0813 K0825 K0837 K0850 K0859
K0814 K0826 K0838 K0851 K0860
K0815 K0827 K0839 K0852 K0861
K0816 K0828 K0840 K0853 K0862
K0820 K0829 K0841 K0854 K0863
K0821 K0830 K0842 K0855 K0864
K0822 K0831 K0843 K0856 K0890
K0823 K0835 K0848 K0857 K0891
K0824 K0836 K0849 K0858 K0898

If you submit codes for services that don’t require prior authorization (for example, K0108), we won’t review them or notify you of any decision. We’ll continue to deny reimbursement for K0108 when billed. If medically necessary, please appeal with the clinical documentation to support the claim.

Continuous glucose monitors requiring prior authorization

We also wanted to remind you of our previous notification about expanding authorization requirements for continuous glucose monitors (Codes: A9277, K0553, S1036) to our commercial EPO and PPO members as of June 1.

Read our April 15 news article reminder.


  • Manual and Power Operated Wheelchairs Medical Policy 365
  • Durable Medical Equipment Payment Policy – Log in and go to Office Resources>Payment Policies.
  • 2022 Fee schedule updates, reminders News Alert – Log in and go to News. Scroll to December 22, 2021 and look for the red exclamation point next to the News Alert titled, “2022 fee schedule updates, reminders."