E0468, Home ventilator, dual-function respiratory device, also performs additional
HCPCS/CPT
Prior Authorization
Prior Auth Required
Code explicitly requires 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.
6 Active Policies
HUMANA-MEDICAL-SUPPLIES-EQUIPMENT-AND-APPLIANCES-DURABLE-MEDICAL-EQUIPMENT-OK-MEDICAID, Medical Supplies, Equipment and Appliances Durable Medical Equipment
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
AMBETTER-CP.MP.184, Home Ventilators
Related Codes
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