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).
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.
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.
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.