E0550, Humidifier, durable for extensive supplemental humidification during ippb
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Clinical documentation establishing that the equipment is necessary and reasonable and is expected to make a meaningful contribution to treatment or functional improvement.
- Documentation that education regarding use of the device was provided and the member/caregiver demonstrated understanding.
- Documentation of a trial of the requested device with evidence the member can use it safely and effectively.
- Documentation that the patient has newly diagnosed nonischemic cardiomyopathy and is undergoing a trial of optimal medical therapy.
Key Coverage Criteria
- Chronic obstructive pulmonary disease;or
- Cystic fibrosis;or
- Diffuse interstitial lung disease;or
- Pulmonary hypertension;or
- Pulmonary neoplasm (primary or metastatic);or
- Dependent edema secondary to right heart failure;or
2 Active Policies
ANTHEM-CG-DME-18, CG-DME-18 Home Oxygen Therapy
AMBETTER-CP.MP.107, Durable Medical Equipment and Orthotics and Prosthetics Guidelines
Related Codes
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