Provider Central

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.

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.

Resources

• 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."

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