E2393
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Powered/motorized wheelchairs, with or without power seating systems, pushrim activated power assist device (an addition to a manual wheelchair to convert to a PAPAW) or power operated vehicles (POVs) are consideredmedically necessarywhenboththegeneral criteriain sectionAbelow are met andoneof thedevice-specific criteriain sectionBis met:
- General Criteria:Individual meetsallof the following criteria:A written assessment by a physician or other appropriate clinician which demonstrates criteriaa, bandcbelow:The individual lacks the functional mobility to complete mobility-related activities of daily living (MRADLs) (for example, toileting, feeding, dressing, grooming, and bathing);andThe individualâs living environment must support the use of a powered/motorized wheelchair, PAPAW or POV;andThe individual is able to consistently o [...]
- Requires a drive-control interface other than a hand or chin-operated standard proportional joystick (for example, head control, sip and puff, switch control);or
- Requires a power tilt or a power recline seating system and the system is being used on the wheelchair;or
- A written assessment by a physician or other appropriate clinician which demonstrates criteriaa, bandcbelow:The individual lacks the functional mobility to complete mobility-related activities of daily living (MRADLs) (for example, toileting, feeding, dressing, grooming, and bathing);andThe individualâs living environment must support the use of a powered/motorized wheelchair, PAPAW or POV;andThe individual is able to consistently operate the prescribed powered/motorized wheelchair, PAPAW or P [...]
- The individual lacks the functional mobility to complete mobility-related activities of daily living (MRADLs) (for example, toileting, feeding, dressing, grooming, and bathing);and
1 Active Policy
ANTHEM-CG-DME-31 — CG-DME-31 Powered Wheeled Mobility Devices
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.