Does E0183 require prior authorization?

No, E0183 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E0183`, Powered pressure reducing underlay/pad, alternating, with pump, includes heavy

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Patients using pressure-reducing support surfaces should have a care plan, which has been established by the patient's physician and home care nurse, which is documented in the patient's medical records, and which generally should include the following: Appropriate management of moisture/incontinence; Appropriate turning and positioning; Appropriate wound care (for stage II, III, or IV ulcer); Education of the patient and caregiver on the prevention and/or management of pressure ulcers; Nutritional assessment and intervention consistent with the overall plan; Regular assessment by a nurse, physician, or other licensed healthcare practitioner.
For group 2: Documentation that the member has been on a comprehensive ulcer treatment program for at least the past month, which has included the use of an appropriate group 1 support surface (comprehensive treatment components listed in policy).
For group 2 prescribed for myocutaneous flap or skin graft: documentation of surgery date; continued use generally considered medically necessary for up to 60 days from date of surgery.

A group 1 mattress overlay or mattress is considered medically necessary DME when the member meets: Altered sensory perception
A group 2 support surface is considered medically necessary DME when: The member has multiple stage II (partial thickness skin loss) pressure ulcers located on the trunk or pelvis, AND The member has been on a comprehensive ulcer treatment program for at least the past month, which has included the use of an appropriate group 1 support surface, AND The member's ulcers have worsened or remained the same over the past month.
A group 1 mattress overlay or mattress is considered medically necessary DME when the member meets: Limited mobility – i.e., member can not independently make changes in body position significant enough to alleviate pressure
A group 1 mattress overlay or mattress is considered medically necessary DME when the member meets: Any stage pressure ulcer on trunk or pelvis
A group 1 mattress overlay or mattress is considered medically necessary DME when the member meets: Fecal or urinary incontinence
A group 1 mattress overlay or mattress is considered medically necessary DME when the member meets: Completely immobile – i.e., member can not make changes in body position without assistance.

ANTHEM-CG-DME-16, CG-DME-16 Pressure-Reducing Support Surfaces

AETNA-CPB-0430, Pressure Reducing Support Surfaces

DME101.001, Hospital Beds and Related Equipment

BCBSIL-DME101.001, Hospital Beds and Related Equipment

BCBSMT-DME101.001, Hospital Beds and Related Equipment

Ask Verity about documentation requirements, denial risks, or coverage in your state.