E0467 — Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Prescription/order from a health care practitioner authorizing the DME item.
- No explicit documentation requirements are stated in this section of the policy.
- Prescription by a health care provider (explicit: items are 'prescribed by a health care provider').
- Documentation that the item is for long-term and/or everyday use in the home (implicit requirement based on definition).
Key Coverage Criteria
- Replacement polycarbonate bottle for use with breast pump (HCPCS A4285).
- Replacement locking ring for breast pump (HCPCS A4286).
- Disposable collection and storage bag for breast milk, any size, any type, each (HCPCS A4287).
- E0910 - Trapeze bars, also known as Patient Helper, attached to bed, with grab bar
- Durable medical equipment (DME), also known as home medical equipment (HME), refers to nondisposable devices prescribed by a health care provider for long-term and/or everyday use in the home.
- It must provide therapeutic benefits or enable the individual to perform certain tasks that they would be unable to perform or otherwise undertake due to certain medical conditions or illnesses.
5 Active Policies
AMBETTER-CP.MP.184 — Home Ventilators
HUMANA-MEDICAL-SUPPLIES-EQUIPMENT-AND-APPLIANCES-DURABLE-MEDICAL-EQUIPMENT-OK-MEDICAID — Medical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - OKLAHOMA
ANTHEM-CG-DME-47 — CG-DME-47 Noninvasive Home Ventilator Therapy for Respiratory Failure
ANTHEM-CG-DME-26 — CG-DME-26 Back-Up Ventilators in the Home Setting
Related Codes
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