Does E1228 require prior authorization?

No, E1228 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E1228`, Special back height for wheelchair

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Home inspection is required to document the environment supports operation of the wheelchair and to evaluate member's ability to operate equipment.
Provider must submit the Wheelchair Medical Necessity and Home Evaluation Verification form as documentation.
Assisted living and similar ADA-required facilities are exempt from needing a home evaluation.
If documentation supports only a manual wheelchair (not power), payment is based on the least costly medically appropriate alternative.

Powered or motorized wheelchairs (with or without power seating systems);or
Power Operated Vehicles [POVs];and
Absent or impaired sensation in the area of contact with the seating surface;or
Options or accessories are consideredmedically necessarywhenALLof the followingdevice,general,andspecificcriteria below (AandBandC) are met:
The accessory or option is forANYof the following wheeled mobility devices (1, 2,or3):Manual Wheelchairs (for example, standard, heavy duty, lightweight, or ultra lightweight);orPowered or motorized wheelchairs (with or without power seating systems);orPower Operated Vehicles [POVs];and
Manual Wheelchairs (for example, standard, heavy duty, lightweight, or ultra lightweight);or

ANTHEM-CG-DME-34, CG-DME-34 Wheeled Mobility Devices: Wheelchair Accessories

BCBSIL-DME101.010, Wheelchairs and Accessories

BCBSMT-DME101.010, Wheelchairs and Accessories

BCBSNM-DME101.010, Wheelchairs and Accessories

BCBSOK-DME101.010, Wheelchairs and Accessories

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